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Girardi P, Rigoni S, Ferrante D, Silvestri S, Angelini A, Cuccaro F, Oddone E, Vicentini M, Barone-Adesi F, Tunesi S, Migliore E, Roncaglia F, Sala O, Pirastu R, Chellini E, Miligi L, Perticaroli P, Bressan V, Merler E, Azzolina D, Marinaccio A, Massari S, Magnani C. Asbestos exposure and asbestosis mortality in Italian cement-asbestos cohorts: Dose-response relationship and the role of competing death causes. Am J Ind Med 2024. [PMID: 38943482 DOI: 10.1002/ajim.23629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 04/17/2024] [Accepted: 06/09/2024] [Indexed: 07/01/2024]
Abstract
OBJECTIVES In Italy, asbestos was used intensively until its ban in 1992, which was extended for asbestos cement factories until 1994. The aim of this study was to evaluate the dose-response between asbestos exposure and asbestosis mortality across a pool of Italian occupational cohorts, taking into account the presence of competing risks. METHODS Cohorts were followed for vital status and the cause of death was ascertained by a linkage with mortality registers. Cause-specific (CS) Cox-regression models were used to evaluate the dose-exposure relationship between asbestosis mortality and the time-dependent cumulative exposure index (CEI) to asbestos. Fine and Gray regression models were computed to assess the effect of competing risks of death. RESULTS The cohort included 12,963 asbestos cement workers. During the follow-up period (1960-2012), of a total of 6961 deaths, we observed 416 deaths attributed to asbestosis, 879 to lung cancer, 400 to primary pleural cancer, 135 to peritoneal cancer, and 1825 to diseases of the circulatory system. The CS model showed a strong association between CEI and asbestosis mortality. Dose-response models estimated an increasing trend in mortality even below a CEI of 25 ff/mL-years. Lung cancer and circulatory diseases were the main competing causes of death. CONCLUSIONS Asbestos exposure among Italian asbestos-cement workers has led to a very high number of deaths from asbestosis and asbestos-related diseases. The increasing risk trend associated with excess deaths, even at low exposure levels, suggests that the proposed limit values would not have been adequate to prevent disability and mortality from asbestosis.
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Affiliation(s)
- Paolo Girardi
- Department of Environmental Sciences, Informatics and Statistics, Ca' Foscari University of Venice, Venezia, Italy
| | - Sara Rigoni
- Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | - Daniela Ferrante
- Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | - Stefano Silvestri
- Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | - Alessia Angelini
- Institute for the Study, Prevention and Oncology Network (ISPRO), Firenze, Italy
| | - Francesco Cuccaro
- Epidemiology and Statistics Unit, Local Health Unit of Barletta-Andria-Trani, Barletta, Italy
| | - Enrico Oddone
- Department of Public Health and Experimental and Forensic Medicine, University of Pavia, Italy
- Hospital Occupational Medicine Unit, ICS Maugeri IRCCS, Pavia, Italy
| | - Massimo Vicentini
- Epidemiology Unit, Local Health Authority-IRCCS of Reggio Emilia, Reggio Emilia, Italy
| | | | - Sara Tunesi
- Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | - Enrica Migliore
- Cancer Epidemiology Unit, AOU Città della Salute e della Scienza di Torino, CPO Piedmont and University of Turin, Torino, Italy
| | - Francesca Roncaglia
- Epidemiology Unit, Local Health Authority-IRCCS of Reggio Emilia, Reggio Emilia, Italy
| | - Orietta Sala
- (former) Regional Asbestos Laboratory ARPAE Emilia-Romagna, Reggio Emilia, Italy
| | - Roberta Pirastu
- (former) "Charles Darwin" Department of Biology and Biotechnology, La Sapienza University, Roma, Italy
| | - Elisabetta Chellini
- (former) Institute for the Study, Prevention and Oncology Network (ISPRO), Firenze, Italy
| | - Lucia Miligi
- Institute for the Study, Prevention and Oncology Network (ISPRO), Firenze, Italy
| | | | | | - Enzo Merler
- (former) Veneto Register of Mesothelioma cases, Regional Epidemiological System, AULSS 6, Padova, Italy
| | - Danila Azzolina
- Department of Environmental Sciences and Prevention, University of Ferrara, Ferrara, Italy
| | - Alessandro Marinaccio
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Unit of Occupational and Environmental Epidemiology, Italian Mesothelioma Register, Italian Workers' Compensation Authority (INAIL), Roma, Italy
| | - Stefania Massari
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Unit of Occupational and Environmental Epidemiology, Italian Mesothelioma Register, Italian Workers' Compensation Authority (INAIL), Roma, Italy
| | - Corrado Magnani
- Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
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Mixed Contaminants: Occurrence, Interactions, Toxicity, Detection, and Remediation. Molecules 2022; 27:molecules27082577. [PMID: 35458775 PMCID: PMC9029723 DOI: 10.3390/molecules27082577] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 04/13/2022] [Accepted: 04/14/2022] [Indexed: 12/18/2022] Open
Abstract
The ever-increasing rate of pollution has attracted considerable interest in research. Several anthropogenic activities have diminished soil, air, and water quality and have led to complex chemical pollutants. This review aims to provide a clear idea about the latest and most prevalent pollutants such as heavy metals, PAHs, pesticides, hydrocarbons, and pharmaceuticals—their occurrence in various complex mixtures and how several environmental factors influence their interaction. The mechanism adopted by these contaminants to form the complex mixtures leading to the rise of a new class of contaminants, and thus resulting in severe threats to human health and the environment, has also been exhibited. Additionally, this review provides an in-depth idea of various in vivo, in vitro, and trending biomarkers used for risk assessment and identifies the occurrence of mixed contaminants even at very minute concentrations. Much importance has been given to remediation technologies to understand our current position in handling these contaminants and how the technologies can be improved. This paper aims to create awareness among readers about the most ubiquitous contaminants and how simple ways can be adopted to tackle the same.
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Fazzo L, Binazzi A, Ferrante D, Minelli G, Consonni D, Bauleo L, Bruno C, Bugani M, De Santis M, Iavarone I, Magnani C, Romeo E, Zona A, Alessi M, Comba P, Marinaccio A. Burden of Mortality from Asbestos-Related Diseases in Italy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:10012. [PMID: 34639316 PMCID: PMC8508095 DOI: 10.3390/ijerph181910012] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 09/16/2021] [Accepted: 09/20/2021] [Indexed: 11/17/2022]
Abstract
Asbestos is one of the major worldwide occupational carcinogens. The global burden of asbestos-related diseases (ARDs) was estimated around 231,000 cases/year. Italy was one of the main European asbestos producers until the 1992 ban. The WHO recommended national programs, including epidemiological surveillance, to eliminate ARDs. The present paper shows the estimate of the burden of mortality from ARDs in Italy, established for the first time. National standardized rates of mortality from mesothelioma and asbestosis and their temporal trends, based on the National Institute of Statistics database, were computed. Deaths from lung cancer attributable to asbestos exposure were estimated using population-based case-control studies. Asbestos-related lung and ovarian cancer deaths attributable to occupational exposure were estimated, considering the Italian occupational cohort studies. In the 2010-2016 period, 4400 deaths/year attributable to asbestos were estimated: 1515 from mesothelioma, 58 from asbestosis, 2830 from lung and 16 from ovarian cancers. The estimates based on occupational cohorts showed that each year 271 deaths from mesothelioma, 302 from lung cancer and 16 from ovarian cancer were attributable to occupational asbestos exposure in industrial sectors with high asbestos levels. The important health impact of asbestos in Italy, 10-25 years after the ban, was highlighted. These results suggest the need for appropriate interventions in terms of prevention, health care and social security at the local level and could contribute to the global estimate of ARDs.
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Affiliation(s)
- Lucia Fazzo
- Department of Environment and Health, Istituto Superiore di Sanità, 00100 Roma, Italy; (C.B.); (M.D.S.); (I.I.); (A.Z.); (P.C.)
| | - Alessandra Binazzi
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Istituto Nazionale per l’Assicurazione Contro gli Infortuni sul Lavoro, 00100 Roma, Italy; (A.B.); (M.B.); (A.M.)
| | - Daniela Ferrante
- Department of Translational Medicine, Università del Piemonte Orientale, 28100 Novara, Italy; (D.F.); (C.M.)
| | - Giada Minelli
- Statistical Service, Istituto Superiore di Sanità, 00100 Roma, Italy;
| | - Dario Consonni
- Epidemiology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20100 Milano, Italy;
| | - Lisa Bauleo
- Department of Epidemiology, Servizio Sanitario Regionale del Lazio, 00100 Roma, Italy; (L.B.); (E.R.)
| | - Caterina Bruno
- Department of Environment and Health, Istituto Superiore di Sanità, 00100 Roma, Italy; (C.B.); (M.D.S.); (I.I.); (A.Z.); (P.C.)
| | - Marcella Bugani
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Istituto Nazionale per l’Assicurazione Contro gli Infortuni sul Lavoro, 00100 Roma, Italy; (A.B.); (M.B.); (A.M.)
| | - Marco De Santis
- Department of Environment and Health, Istituto Superiore di Sanità, 00100 Roma, Italy; (C.B.); (M.D.S.); (I.I.); (A.Z.); (P.C.)
| | - Ivano Iavarone
- Department of Environment and Health, Istituto Superiore di Sanità, 00100 Roma, Italy; (C.B.); (M.D.S.); (I.I.); (A.Z.); (P.C.)
| | - Corrado Magnani
- Department of Translational Medicine, Università del Piemonte Orientale, 28100 Novara, Italy; (D.F.); (C.M.)
| | - Elisa Romeo
- Department of Epidemiology, Servizio Sanitario Regionale del Lazio, 00100 Roma, Italy; (L.B.); (E.R.)
| | - Amerigo Zona
- Department of Environment and Health, Istituto Superiore di Sanità, 00100 Roma, Italy; (C.B.); (M.D.S.); (I.I.); (A.Z.); (P.C.)
| | - Mariano Alessi
- Department of Prevention, Ministry of Health, 00100 Roma, Italy;
| | - Pietro Comba
- Department of Environment and Health, Istituto Superiore di Sanità, 00100 Roma, Italy; (C.B.); (M.D.S.); (I.I.); (A.Z.); (P.C.)
| | - Alessandro Marinaccio
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Istituto Nazionale per l’Assicurazione Contro gli Infortuni sul Lavoro, 00100 Roma, Italy; (A.B.); (M.B.); (A.M.)
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