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Cordiano R, Papa V, Cicero N, Spatari G, Allegra A, Gangemi S. Effects of Benzene: Hematological and Hypersensitivity Manifestations in Resident Living in Oil Refinery Areas. TOXICS 2022; 10:678. [PMID: 36355969 PMCID: PMC9697938 DOI: 10.3390/toxics10110678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 10/30/2022] [Accepted: 10/31/2022] [Indexed: 06/16/2023]
Abstract
Literature is teeming with publications on industrial pollution. Over the decades, the main industrial pollutants and their effects on human health have been widely framed. Among the various compounds involved, benzene plays a leading role in the onset of specific diseases. Two systems are mainly affected by the adverse health effects of benzene exposure, both acute and chronic: the respiratory and hematopoietic systems. The most suitable population targets for a proper damage assessment on these systems are oil refinery workers and residents near refining plants. Our work fits into this area of interest with the aim of reviewing the most relevant cases published in the literature related to the impairment of the aforementioned systems following benzene exposure. We perform an initial debate between the two clinical branches that see a high epidemiological expression in this slice of the population examined: residents near petroleum refinery areas worldwide. In addition, the discussion expands on highlighting the main immunological implications of benzene exposure, finding a common pathophysiological denominator in inflammation, oxidative stress, and DNA damage, thus helping to set the basis for an increasingly detailed characterization aimed at identifying common molecular patterns between the two clinical fields discussed.
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Affiliation(s)
- Raffaele Cordiano
- Department of Clinical and Experimental Medicine, School and Operative Unit of Allergy and Clinical Immunology, University of Messina, 98125 Messina, Italy
| | - Vincenzo Papa
- Department of Clinical and Experimental Medicine, School and Operative Unit of Allergy and Clinical Immunology, University of Messina, 98125 Messina, Italy
| | - Nicola Cicero
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, 98168 Messina, Italy
| | - Giovanna Spatari
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, 98168 Messina, Italy
| | - Alessandro Allegra
- Division of Hematology, Department of Human Pathology in Adulthood and Childhood “Gaetano Barresi”, University of Messina, 98125 Messina, Italy
| | - Sebastiano Gangemi
- Department of Clinical and Experimental Medicine, School and Operative Unit of Allergy and Clinical Immunology, University of Messina, 98125 Messina, Italy
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McLoone P, Dyussupov O, Nurtlessov Z, Kenessariyev U, Kenessary D. The effect of exposure to crude oil on the immune system. Health implications for people living near oil exploration activities. INTERNATIONAL JOURNAL OF ENVIRONMENTAL HEALTH RESEARCH 2021; 31:762-787. [PMID: 31709802 DOI: 10.1080/09603123.2019.1689232] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 11/01/2019] [Indexed: 06/10/2023]
Abstract
People who reside near oil exploration activities may be exposed to toxins from gas flares or oil spills. The impact of such exposures on the human immune system has not been fully investigated. In this review, research investigating the effects of crude oil on the immune system is evaluated. The aim was to obtain a greater understanding of the possible immunological impact of living near oil exploration activities. In animals, the effect of exposure to crude oil on the immune system depends on the species, dose, exposure route, and type of oil. Important observations included; hematological changes resulting in anemia and alterations in white blood cell numbers, lymph node and splenic atrophy, genotoxicity in immune cells, modulation of cytokine gene expression and increased susceptibility to infectious diseases. In humans, there are reports that exposure to crude oil can increase the risk of developing certain types of cancer and cause immunomodulation.Abbreviations: A1AT: alpha-1 antitrypsin; ACH50: hemolytic activity of the alternative pathway; AHR: aryl hydrocarbon receptor; BALF: bronchoalveolar lavage fluid; COPD: chronic obstructive pulmonary disease; CYP: cytochrome P450; DNFB: 2, 4-dinitro-1-fluorobenzene; G-CSF: granulocyte-colony stimulating factor; IFN: interferon; IL: interleukin; 8-IP: 8-isoprostane; ISG15: interferon stimulated gene; LPO: lipid peroxidation; LTB4: leukotriene B4; M-CSF: macrophage-colony stimulating factor; MMC: melanomacrophage center; MPV: mean platelet volume; NK: natural killer; OSPM: oil sail particulate matter; PAH: polycyclic aromatic hydrocarbon; PBMC: peripheral blood mononuclear cell; PCV: packed cell volume; RBC: red blood cell; ROS: reactive oxygen species; RR: relative risk; TH: T helper; TNF: tumour necrosis factor; UV: ultraviolet; VNNV: Viral Nervous Necrosis Virus; WBC: white blood cell.
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Affiliation(s)
- Pauline McLoone
- Department of Biomedical Sciences, Nazarbayev University School of Medicine, Astana, Kazakhstan
| | - Olzhas Dyussupov
- Department of Biomedical Sciences, Nazarbayev University School of Medicine, Astana, Kazakhstan
| | - Zhaxybek Nurtlessov
- Department of Biomedical Sciences, Nazarbayev University School of Medicine, Astana, Kazakhstan
| | - Ussen Kenessariyev
- Department of General Hygiene and Ecology, Kazakh National Medical University, Almaty, Kazakhstan
| | - Dinara Kenessary
- Department of General Hygiene and Ecology, Kazakh National Medical University, Almaty, Kazakhstan
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Onyije FM, Hosseini B, Togawa K, Schüz J, Olsson A. Cancer Incidence and Mortality among Petroleum Industry Workers and Residents Living in Oil Producing Communities: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:4343. [PMID: 33923944 PMCID: PMC8073871 DOI: 10.3390/ijerph18084343] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 04/14/2021] [Accepted: 04/16/2021] [Indexed: 12/28/2022]
Abstract
Petroleum extraction and refining are major sources of various occupational exposures and of air pollution and may therefore contribute to the global cancer burden. This systematic review and meta-analysis is aimed at evaluating the cancer risk in petroleum-exposed workers and in residents living near petroleum facilities. Relevant studies were identified and retrieved through PubMed and Web of Science databases. Summary effect size (ES) and 95% confidence intervals (CI) were analysed using random effect models, and heterogeneity across studies was assessed (I2). Overall, petroleum industry work was associated with an increased risk of mesothelioma (ES = 2.09, CI: 1.58-2.76), skin melanoma (ES = 1.34, CI: 1.06-1.70 multiple myeloma (ES =1.81, CI: 1.28-2.55), and cancers of the prostate (ES = 1.13, Cl: 1.05-1.22) and urinary bladder (ES = 1.25, CI: 1.09-1.43) and a decreased risk of cancers of the esophagus, stomach, colon, rectum, and pancreas. Offshore petroleum work was associated with an increased risk of lung cancer (ES = 1.20; 95% CI: 1.03-1.39) and leukemia (ES = 1.47; 95% CI: 1.12-1.92) in stratified analysis. Residential proximity to petroleum facilities was associated with childhood leukemia (ES = 1.90, CI: 1.34-2.70). Very few studies examined specific exposures among petroleum industry workers or residents living in oil producing communities. The present review warrants further studies on specific exposure levels and pathways among petroleum-exposed workers and residents living near petroleum facilities.
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Affiliation(s)
- Felix M. Onyije
- Environment and Lifestyle Epidemiology Branch, International Agency for Research on Cancer (IARC/WHO), 150 Cours Albert Thomas, CEDEX 08, 69372 Lyon, France; (B.H.); (K.T.); (J.S.); (A.O.)
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Boonhat H, Lin RT. Association between leukemia incidence and mortality and residential petrochemical exposure: A systematic review and meta-analysis. ENVIRONMENT INTERNATIONAL 2020; 145:106090. [PMID: 32932064 DOI: 10.1016/j.envint.2020.106090] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 08/12/2020] [Accepted: 08/22/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND The global burden of leukemia, which grew by 19% from 2007 to 2017, poses a threat to human development and global cancer control. Factors contributing to this growth include massive industrial pollution, especially from large-scale petrochemical industry complexes (PICs). Globally, around 700 PICs are continuously operating. Data on the impact of PICs on leukemia incidence and mortality in residents are sparse and inconsistent. OBJECTIVE To determine the association between residential exposure to PICs and leukemia incidence and mortality using systematic review and meta-analysis. METHODS The studies were identified through seven databases (Clinical Key, Cochrane Library, EBSCOhost, Embase, PubMed, ScienceDirect, and Web of Science). We screened the eligibility of studies using following criteria: (1) observational studies that focused on residential exposure to PICs; (2) exposure group that was defined as residents living close to PICs; (3) outcome that was defined as all leukemia incidence and mortality; and (4) available population data. We applied the Grading of Recommendations Assessment, Development, and Evaluation to assess the certainty of evidence. The random-effects model used to estimate the pooled effects in the meta-analysis. RESULTS We identified thirteen epidemiologic studies (including eleven for leukemia incidence, one for leukemia mortality, and one for both), covering 125,580 individuals from Croatia, Finland, Italy, Serbia, Spain, Sweden, Taiwan, the United Kingdom, and the United States. We found moderate certainty of evidence indicated the risk of leukemia incidence (relative risk [RR] = 1.18; 95% CI = 1.03-1.35) and mortality (RR = 1.26; 95% CI = 1.10-1.45) in residents living close to PICs. Our subgroup analysis found increased RRs for leukemia incidence in studies using distance-based exposure indicator (RR = 1.11; 95% CI = 1.00-1.23), and with longer follow-up periods (RR = 1.24; 95% CI = 1.06-1.45). CONCLUSION Our analysis provides low-certainty evidence of increased leukemia incidence and moderate-certainty evidence of increased leukemia mortality among residents living close to PICs. While the global petrochemicals sector is growing, our findings suggest the need to consider disease prevention and pollution control measures during the development of PICs.
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Affiliation(s)
- Hathaichon Boonhat
- Graduate Institute of Public Health, College of Public Health, China Medical University, Taichung 406, Taiwan
| | - Ro-Ting Lin
- Department of Occupational Safety and Health, College of Public Health, China Medical University, Taichung 406, Taiwan.
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Domingo JL, Marquès M, Nadal M, Schuhmacher M. Health risks for the population living near petrochemical industrial complexes. 1. Cancer risks: A review of the scientific literature. ENVIRONMENTAL RESEARCH 2020; 186:109495. [PMID: 32283337 DOI: 10.1016/j.envres.2020.109495] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 04/05/2020] [Accepted: 04/05/2020] [Indexed: 06/11/2023]
Abstract
Petrochemical complexes and oil refineries are well known sources of a wide range of environmental pollutants. Consequently, the potential harmful health effects of living near these facilities is a topic of concern among the population living in the neighborhood. Anyhow, the number of studies carried out on this issue is rather limited and, in some cases, results are even slightly contradictory. The present Review was aimed at assessing whether living in the vicinity of petrochemical industries and oil refineries is associated with a higher incidence of cancer and cancer mortality. In this sense, up to 23 investigations were found in PubMed and Scopus databases. According to the type of cancer, leukemia and other hematological malignancies were reported as the main types of cancer for populations living in the neighborhood of petrochemical industries. This was concluded based on studies performed in Taiwan, Spain, United Kingdom, Italy and Nigeria. In contrast, no association was found in 4 different investigations conducted in Sweden, Finland and USA with the same purpose. Other scientific studies reported a high incidence of lung and bladder cancer in Taiwan, Italy and USA, as well as an excess mortality of bone, brain, liver, pleural, larynx and pancreas cancers in individuals living near petrochemical complexes from Taiwan, Spain, Italy, United Kingdom and USA. Thus, human exposure to certain carcinogenic pollutants emitted from petrochemical industries might increase the incidence of some cancers and cancer mortality. Anyway, since the limited number of investigations conducted until now, further studies are required in order to corroborate -in a more generalized way-this conclusion.
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Affiliation(s)
- José L Domingo
- Laboratory of Toxicology and Environmental Health, School of Medicine, IISPV, Universitat Rovira I Virgili, Sant Llorens 21, 43201, Reus, Catalonia, Spain.
| | - Montse Marquès
- Laboratory of Toxicology and Environmental Health, School of Medicine, IISPV, Universitat Rovira I Virgili, Sant Llorens 21, 43201, Reus, Catalonia, Spain
| | - Martí Nadal
- Laboratory of Toxicology and Environmental Health, School of Medicine, IISPV, Universitat Rovira I Virgili, Sant Llorens 21, 43201, Reus, Catalonia, Spain
| | - Marta Schuhmacher
- Departament d'Enginyeria Química, Universitat Rovira I Virgili, Avd. Països Catalans 26, 43007, Tarragona, Catalonia, Spain
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Loftus C, Afsharinejad Z, Sampson P, Vedal S, Torres E, Arias G, Tchong-French M, Karr C. Estimated time-varying exposures to air emissions from animal feeding operations and childhood asthma. Int J Hyg Environ Health 2019; 223:187-198. [PMID: 31543304 DOI: 10.1016/j.ijheh.2019.09.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 09/08/2019] [Accepted: 09/08/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND/AIM Industrial-scale animal feeding operations (AFOs) have adverse impacts on regional air quality. Air emissions include endotoxins and other pro-inflammatory components, and exposure may cause airway inflammation and respiratory effects in susceptible individuals residing nearby. We aimed to develop and validate metrics for estimating time-varying exposure to AFO air pollution in surrounding communities and, secondly, to determine whether exposure is associated with health effects in children with asthma. METHODS We conducted a longitudinal panel study of N = 58 children with asthma in an agricultural region of Washington State with a high density of dairy AFOs. Children were followed for up to 26 months with repeated measures of respiratory health (N = 2023 interviews; N = 3853 lung function measurements); urine was collected in a subcohort (N = 16) at six-day intervals over three months and analyzed for leukotriene E4 (LTE4), a biomarker of systemic inflammation (N = 138 measurements). We developed an approach to estimate daily exposure to AFO airborne emissions based on distance to AFOs, AFO size, and daily wind speed and direction, and validated the estimates against direct measurements of ammonia, a chemical marker of AFO emissions, measured biweekly at 18 sites across the region for 14 months. Short-term relationships between AFO pollutant exposure and outcomes were assessed using regression models accounting for within-participant correlation and several potential confounders. RESULTS Estimates of daily AFO air pollution correlated moderately well with outdoor ammonia measurements (N = 842; r = 0.62). Forced expiratory volume in 1 s (FEV1) as percent of predicted was 2.0% (95% CI: 0.5, 3.5) lower with each interquartile increase in previous day exposure, but no associations with asthma symptoms were observed. There was suggestive evidence that LTE4 concentrations were higher following days of elevated exposure to AFO emissions (p = 0.06). CONCLUSIONS A simple metric of time-varying exposure to AFO emissions was correlated with daily outdoor ammonia levels. Children with asthma may be adversely affected by exposure to AFO emissions.
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Affiliation(s)
- Christine Loftus
- Department of Environmental and Occupational Health Sciences, School of Public Health, Box 357234, University of Washington, Seattle, WA, 98195, United States.
| | - Zahra Afsharinejad
- Department of Environmental and Occupational Health Sciences, School of Public Health, Box 357234, University of Washington, Seattle, WA, 98195, United States
| | - Paul Sampson
- Department of Statistics, College of Arts and Sciences, Box 354322, University of Washington, Seattle, WA, 98195, United States
| | - Sverre Vedal
- Department of Environmental and Occupational Health Sciences, School of Public Health, Box 357234, University of Washington, Seattle, WA, 98195, United States
| | - Elizabeth Torres
- Northwest Communities Education Center, Radio KDNA, 121 Sunnyside Ave, Granger, WA, 98932, United States
| | - Griselda Arias
- Yakima Valley Farm Workers Clinic, Yakima, WA, United States
| | - Maria Tchong-French
- Department of Environmental and Occupational Health Sciences, School of Public Health, Box 357234, University of Washington, Seattle, WA, 98195, United States
| | - Catherine Karr
- Department of Environmental and Occupational Health Sciences, School of Public Health, Box 357234, University of Washington, Seattle, WA, 98195, United States; Department of Pediatrics, School of Medicine, Box 356320, University of Washington, Seattle, WA, 98195, United States
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Kampeerawipakorn O, Navasumrit P, Settachan D, Promvijit J, Hunsonti P, Parnlob V, Nakngam N, Choonvisase S, Chotikapukana P, Chanchaeamsai S, Ruchirawat M. Health risk evaluation in a population exposed to chemical releases from a petrochemical complex in Thailand. ENVIRONMENTAL RESEARCH 2017; 152:207-213. [PMID: 27792945 DOI: 10.1016/j.envres.2016.10.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Revised: 09/12/2016] [Accepted: 10/08/2016] [Indexed: 05/28/2023]
Abstract
Emissions from petrochemical industries may contain toxic and carcinogenic compounds that can pose health risk to human populations. The scenario may be worse in developing countries where management of such exposure-health problems is typically not well-implemented and the public may not be well-informed about such health risk. In Thailand, increasing incidences of respiratory diseases and cancers have been reported for the population around a major petrochemical complex, the Map Ta Phut Industrial Estate (MTPIE). This study aimed to systematically investigate an exposure-health risk among these populations. One-hundred and twelve healthy residents living nearby MTPIE and 50 controls located approximately 40km from MTPIE were recruited. Both external and internal exposure doses to benzene and 1,3-butadiene, known to be associated with the types of cancer that are of concern, were measured because they represent exposure to industrial and/or traffic-related emissions. Health risk was assessed using the biomarkers of early biological effects for cancer and inflammatory responses, as well as biomarkers of exposure for benzene and 1,3-butadiene. The exposure levels of benzene and 1,3-butadiene were similar for both the exposed and control groups. This was confirmed by a non-significant difference in the levels of specific urinary metabolites for benzene (trans,trans-muconic acid, t,t-MA) and 1,3-butadiene (monohydroxy-butyl mercapturic acid, MHBMA). Levels of 8-hydroxydeoxyguanosine (8-OHdG) and DNA strand breaks between the two groups were not statistically significantly different. However, functional biomarkers, interleukin-8 (IL-8) expression was significantly higher (p<0.01) and DNA repair capacity was lower (p<0.05) in the exposed residents compared to the control subjects. This suggests that the exposed residents may have a higher risk for development of diseases such as cancer compared to controls. However, the increased expression of IL-8 and lower DNA repair capacity were not associated with recent and excessive exposure to benzene and 1,3-butadiene, which were at the similar levels as those in the controls. The data would indicate that previous exposure to the two chemicals together with exposure to other toxic chemicals from the MTPIE may be responsible for the elevated functional biomarkers and health risk. Further studies are required to determine which other pollutants from the industrial complex could be causing these functional abnormalities.
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Affiliation(s)
- Ormrat Kampeerawipakorn
- Laboratory of Environmental Toxicology, Chulabhorn Research Institute, Lak Si, Bangkok, Thailand
| | - Panida Navasumrit
- Laboratory of Environmental Toxicology, Chulabhorn Research Institute, Lak Si, Bangkok, Thailand; Chulabhorn Graduate Institute, Lak Si, Bangkok, Thailand; Center of Excellence on Environmental Health and Toxicology, CHE, Ministry of Education, Thailand
| | - Daam Settachan
- Laboratory of Environmental Toxicology, Chulabhorn Research Institute, Lak Si, Bangkok, Thailand; Chulabhorn Graduate Institute, Lak Si, Bangkok, Thailand
| | - Jeerawan Promvijit
- Laboratory of Environmental Toxicology, Chulabhorn Research Institute, Lak Si, Bangkok, Thailand
| | - Potchanee Hunsonti
- Laboratory of Environmental Toxicology, Chulabhorn Research Institute, Lak Si, Bangkok, Thailand
| | - Varabhorn Parnlob
- Laboratory of Environmental Toxicology, Chulabhorn Research Institute, Lak Si, Bangkok, Thailand
| | - Netnapa Nakngam
- Laboratory of Environmental Toxicology, Chulabhorn Research Institute, Lak Si, Bangkok, Thailand
| | - Suppachai Choonvisase
- Laboratory of Environmental Toxicology, Chulabhorn Research Institute, Lak Si, Bangkok, Thailand
| | | | - Samroeng Chanchaeamsai
- Laboratory of Environmental Toxicology, Chulabhorn Research Institute, Lak Si, Bangkok, Thailand
| | - Mathuros Ruchirawat
- Laboratory of Environmental Toxicology, Chulabhorn Research Institute, Lak Si, Bangkok, Thailand; Center of Excellence on Environmental Health and Toxicology, CHE, Ministry of Education, Thailand.
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Di Salvo F, Meneghini E, Vieira V, Baili P, Mariottini M, Baldini M, Micheli A, Sant M. Spatial variation in mortality risk for hematological malignancies near a petrochemical refinery: A population-based case-control study. ENVIRONMENTAL RESEARCH 2015; 140:641-8. [PMID: 26073202 PMCID: PMC4492869 DOI: 10.1016/j.envres.2015.05.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Revised: 05/15/2015] [Accepted: 05/26/2015] [Indexed: 06/04/2023]
Abstract
INTRODUCTION The study investigated the geographic variation of mortality risk for hematological malignancies (HMs) in order to identify potential high-risk areas near an Italian petrochemical refinery. MATERIAL AND METHODS A population-based case-control study was conducted and residential histories for 171 cases and 338 sex- and age-matched controls were collected. Confounding factors were obtained from interviews with consenting relatives for 109 HM deaths and 267 controls. To produce risk mortality maps, two different approaches were applied and compared. We mapped (1) adaptive kernel density relative risk estimation for case-control studies which estimates a spatial relative risk function using the ratio between cases and controls' densities, and (2) estimated odds ratios for case-control study data using Generalized Additive Models (GAMs) to smooth the effect of location, a proxy for exposure, while adjusting for confounding variables. RESULTS No high-risk areas for HM mortality were identified among all subjects (men and women combined), by applying both approaches. Using the adaptive KDE approach, we found a significant increase in death risk only among women in a large area 2-6 km southeast of the refinery and the application of GAMs also identified a similarly-located significant high-risk area among women only (global p-value<0.025). Potential confounding risk factors we considered in the GAM did not alter the results. CONCLUSION Both approaches identified a high-risk area close to the refinery among women only. Those spatial methods are useful tools for public policy management to determine priority areas for intervention. Our findings suggest several directions for further research in order to identify other potential environmental exposures that may be assessed in forthcoming studies based on detailed exposure modeling.
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Affiliation(s)
- Francesca Di Salvo
- Analytical Epidemiology and Health Impact Unit, Department of Preventive and Predictive Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
| | - Elisabetta Meneghini
- Analytical Epidemiology and Health Impact Unit, Department of Preventive and Predictive Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Veronica Vieira
- Program in Public Health, Chao Family Comprehensive Cancer Center, University of California, Irvine, CA 92697, USA
| | - Paolo Baili
- Analytical Epidemiology and Health Impact Unit, Department of Preventive and Predictive Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Mauro Mariottini
- Osservatorio Epidemiologico Ambientale Regione Marche, ARPAM, Servizio Epidemiologia Ambientale, Ancona, Italy
| | - Marco Baldini
- Osservatorio Epidemiologico Ambientale Regione Marche, ARPAM, Servizio Epidemiologia Ambientale, Ancona, Italy
| | - Andrea Micheli
- Scientific Direction, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Milena Sant
- Analytical Epidemiology and Health Impact Unit, Department of Preventive and Predictive Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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