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Curti S, Gallo M, Ferrante D, Bella F, Boschetti L, Casotto V, Ceppi M, Cervino D, Fazzo L, Fedeli U, Giorgi Rossi P, Giovannetti L, Girardi P, Lando C, Migliore E, Miligi L, Oddone E, Perlangeli V, Pernetti R, Piro S, Storchi C, Tumino R, Zona A, Zorzi M, Brandi G, Ferretti S, Magnani C, Marinaccio A, Mattioli S. Cholangiocarcinoma and Occupational Exposure to Asbestos: Insights From the Italian Pooled Cohort Study. Med Lav 2024; 115:e2024016. [PMID: 38686579 DOI: 10.23749/mdl.v115i2.14649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 04/10/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND Recent studies supported the association between occupational exposure to asbestos and risk of cholangiocarcinoma (CC). Aim of the present study is to investigate this association using an update of mortality data from the Italian pooled asbestos cohort study and to test record linkage to Cancer Registries to distinguish between hepatocellular carcinoma (HCC) and intrahepatic/extrahepatic forms of CC. METHODS The update of a large cohort study pooling 52 Italian industrial cohorts of workers formerly exposed to asbestos was carried out. Causes of death were coded according to ICD. Linkage was carried out for those subjects who died for liver or bile duct cancer with data on histological subtype provided by Cancer Registries. RESULTS 47 cohorts took part in the study (57,227 subjects). We identified 639 causes of death for liver and bile duct cancer in the 44 cohorts covered by Cancer Registry. Of these 639, 240 cases were linked to Cancer Registry, namely 14 CC, 83 HCC, 117 cases with unspecified histology, 25 other carcinomas, and one case of cirrhosis (likely precancerous condition). Of the 14 CC, 12 occurred in 2010-2019, two in 2000-2009, and none before 2000. CONCLUSION Further studies are needed to explore the association between occupational exposure to asbestos and CC. Record linkage was hampered due to incomplete coverage of the study areas and periods by Cancer Registries. The identification of CC among unspecific histology cases is fundamental to establish more effective and targeted liver cancer screening strategies.
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Affiliation(s)
- Stefania Curti
- Department of Medical and Surgical Sciences, University of Bologna, Italy
| | - Mena Gallo
- Department of Medical and Surgical Sciences, University of Bologna, Italy
| | - Daniela Ferrante
- Unit of Medical Statistics, Department of Translational Medicine, Università del Piemonte Orientale and Cancer Epidemiology Unit, CPO-Piemonte, Novara, Italy
| | - Francesca Bella
- Syracuse Cancer Registry, Provincial Health Authority of Syracuse, Italy
| | | | - Veronica Casotto
- Epidemiological Department, Azienda Zero, Veneto Region, Padova, Italy
| | - Marcello Ceppi
- Clinical Epidemiology Unit, IRCCS-Ospedale Policlinico San Martino, Genoa, Italy
| | | | - Lucia Fazzo
- Department of Environment and Health, Istituto Superiore di Sanità, Roma, Italy
| | - Ugo Fedeli
- Epidemiological Department, Azienda Zero, Veneto Region, Padova, Italy
| | - Paolo Giorgi Rossi
- Epidemiology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Lucia Giovannetti
- Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy
| | - Paolo Girardi
- Department of Environmental Sciences, Informatics and Statistics, Ca' Foscari University of Venice, Venice, Italy
| | - Cecilia Lando
- Clinical Epidemiology Unit, IRCCS-Ospedale Policlinico San Martino, Genoa, Italy
| | - Enrica Migliore
- Unit of Cancer Epidemiology, Regional Operating Center of Piemonte (COR Piemonte), University of Torino and CPO-Piemonte, Torino, Italy
| | - Lucia Miligi
- Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy
| | - Enrico Oddone
- Department of Public Health, Experimental and Forensic Medicine - University of Pavia, Pavia, Italy
| | | | - Roberta Pernetti
- Department of Public Health, Experimental and Forensic Medicine - University of Pavia, Pavia, Italy
| | - Sara Piro
- Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy
| | - Cinzia Storchi
- Epidemiology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Rosario Tumino
- Syracuse Cancer Registry, Provincial Health Authority of Syracuse, Italy
| | - Amerigo Zona
- Department of Environment and Health, Istituto Superiore di Sanità, Roma, Italy
| | - Manuel Zorzi
- Epidemiological Department, Azienda Zero, Veneto Region, Padova, Italy
| | - Giovanni Brandi
- Department of Medical and Surgical Sciences, University of Bologna, Italy; Oncology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy
| | - Stefano Ferretti
- Emilia-Romagna Cancer Registry, Ferrara Unit, Local Health Authority, Ferrara; and University of Ferrara, Italy
| | - Corrado Magnani
- Unit of Medical Statistics, Department of Translational Medicine, Università del Piemonte Orientale and Cancer Epidemiology Unit, CPO-Piemonte, Novara, Italy
| | - Alessandro Marinaccio
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Italian Workers' Compensation Authority, Rome, Italy
| | - Stefano Mattioli
- Department of Environmental and Prevention Sciences, University of Ferrara, Italy
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Fazzo L, Grande E, Zona A, Minelli G, Crialesi R, Iavarone I, Grippo F. Mortality rates from asbestos-related diseases in Italy during the first year of the COVID-19 pandemic. Front Public Health 2024; 11:1243261. [PMID: 38292377 PMCID: PMC10824953 DOI: 10.3389/fpubh.2023.1243261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 11/07/2023] [Indexed: 02/01/2024] Open
Abstract
Background and aim Patients with interstitial lung diseases, including asbestosis, showed high susceptibility to the SARS-CoV-2 virus and a high risk of severe COVID-19 symptoms. Italy, highly impacted by asbestos-related diseases, in 2020 was among the European countries with the highest number of COVID-19 cases. The mortality related to malignant mesotheliomas and asbestosis in 2020 and its relationship with COVID-19 in Italy are investigated. Methods All death certificates involving malignant mesotheliomas or asbestosis in 2010-2020 and those involving COVID-19 in 2020 were retrieved from the National Registry of Causes of Death. Annual mortality rates and rate ratios (RRs) of 2020 and 2010-2014 compared to 2015-2019 were calculated. The association between malignant pleural mesothelioma (MPM) and asbestosis with COVID-19 in deceased adults ≥80 years old was evaluated through a logistic regression analysis (odds ratios: ORs), using MPM and asbestosis deaths COVID-19-free as the reference group. The hospitalization for asbestosis in 2010-2020, based on National Hospital Discharge Database, was analyzed. Results In 2020, 746,343 people died; out of them, 1,348 involved MPM and 286 involved asbestosis. Compared to the period 2015-2019, the mortality involving the two diseases decreased in age groups below 80 years; meanwhile, an increasing trend was observed in subjects aged 80 years and older, with a relative mortality risks of 1.10 for MPM and 1.17 for asbestosis. In subjects aged ≥80 years, deaths with COVID-19 were less likely to have MPM in both genders (men: OR = 0.22; women: OR = 0.44), while no departure was observed for asbestosis. A decrease in hospitalization in 2020 with respect to those in 2010-2019 in all age groups, both considering asbestosis as the primary or secondary diagnosis, was observed. Conclusions The increasing mortality involving asbestosis and, even if of slight entity, MPM, observed in people aged over 80 years during the 1st year of the COVID-19 pandemic, aligned in part with the previous temporal trend, could be due to several factors. Although no positive association with COVID-19 mortality was observed, the decrease in hospitalizations for asbestosis among individuals aged over 80 years, coupled with the increase in deaths, highlights the importance of enhancing home-based assistance during the pandemic periods for vulnerable patients with asbestos-related conditions.
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Affiliation(s)
- Lucia Fazzo
- Department of Environment and Health, Istituto Superiore di Sanità, Rome, Italy
- World Health Organization Collaborating Centre for Environmental Health in Contaminated Sites, Rome, Italy
| | - Enrico Grande
- Integrated System for Health, Social Assistance and Welfare, Italian National Institute of Statistics, Rome, Italy
| | - Amerigo Zona
- Department of Environment and Health, Istituto Superiore di Sanità, Rome, Italy
- World Health Organization Collaborating Centre for Environmental Health in Contaminated Sites, Rome, Italy
| | - Giada Minelli
- Statistical Service, Istituto Superiore di Sanità, Rome, Italy
| | - Roberta Crialesi
- Integrated System for Health, Social Assistance and Welfare, Italian National Institute of Statistics, Rome, Italy
| | - Ivano Iavarone
- Department of Environment and Health, Istituto Superiore di Sanità, Rome, Italy
- World Health Organization Collaborating Centre for Environmental Health in Contaminated Sites, Rome, Italy
| | - Francesco Grippo
- Integrated System for Health, Social Assistance and Welfare, Italian National Institute of Statistics, Rome, Italy
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Ferrante D, Angelini A, Barbiero F, Barbone F, Bauleo L, Binazzi A, Bovenzi M, Bruno C, Casotto V, Cernigliaro A, Ceppi M, Cervino D, Chellini E, Curti S, De Santis M, Fazzo L, Fedeli U, Fiorillo G, Franchi A, Gangemi M, Giangreco M, Rossi PG, Girardi P, Luberto F, Massari S, Mattioli S, Menegozzo S, Merlo DF, Michelozzi P, Migliore E, Miligi L, Oddone E, Pernetti R, Perticaroli P, Piro S, Addario SP, Romeo E, Roncaglia F, Silvestri S, Storchi C, Zona A, Magnani C, Marinaccio A. Cause specific mortality in an Italian pool of asbestos workers cohorts. Am J Ind Med 2024; 67:31-43. [PMID: 37855384 DOI: 10.1002/ajim.23546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 10/03/2023] [Accepted: 10/06/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND Asbestos is a known human carcinogen and is causally associated with malignant mesothelioma, lung, larynx and ovarian cancers. METHODS Cancer risk was studied among a pool of formerly asbestos-exposed workers in Italy. Fifty-two Italian asbestos cohorts (asbestos-cement, rolling-stock, shipbuilding, and other) were pooled and their mortality follow-up was updated to 2018. Standardized mortality ratios (SMRs) were computed for major causes of death considering duration of exposure and time since first exposure (TSFE), using reference rates by region, age and calendar period. RESULTS The study included 63,502 subjects (57,156 men and 6346 women): 40% who were alive, 58% who died (cause known for 92%), and 2% lost to follow-up. Mortality was increased for all causes (SMR: men = 1.04, 95% confidence interval [CI] 1.03-1.05; women = 1.15, 95% CI 1.11-1.18), all malignancies (SMR: men = 1.21, 95% CI 1.18-1.23; women = 1.29, 95% CI 1.22-1.37), pleural and peritoneal malignancies (men: SMR = 10.46, 95% CI 9.86-11.09 and 4.29, 95% CI 3.66-5.00; women: SMR = 27.13, 95% CI 23.29-31.42 and 7.51, 95% CI 5.52-9.98), lung (SMR: men = 1.28, 95% CI 1.24-1.32; women = 1.26, 95% CI 1.02-1.53), and ovarian cancer (SMR = 1.42, 95% CI 1.08-1.84). Pleural cancer mortality increased during the first 40 years of TSFE (latency), reaching a plateau thereafter. CONCLUSIONS Analyses by time-dependent variables showed that the risk for pleural neoplasms increased with latency and no longer increases at long TSFE, consistent with with asbestos clearance from the lungs. Peritoneal neoplasm risk increased over all observation time.
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Affiliation(s)
- Daniela Ferrante
- Department of Translational Medicine, Università del Piemonte Orientale and CPO Piemonte, Novara, Italy
| | - Alessia Angelini
- Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy
| | - Fabiano Barbiero
- Department of Medical Area (DAME), University of Udine, Udine, Italy
| | - Fabio Barbone
- Department of Medical Sciences, University of Trieste, Trieste, Italy
| | - Lisa Bauleo
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | - Alessandra Binazzi
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Italian Workers' Compensation Authority, Rome, Italy
| | - Massimo Bovenzi
- Department of Medical Sciences, Clinical Unit of Occupational Medicine, University of Trieste, Trieste, Italy
| | - Caterina Bruno
- Department of Environment and Health, Istituto Superiore di Sanità, Roma, Italy
| | - Veronica Casotto
- Epidemiological Department, Azienda Zero, Padova, Veneto Region, Italy
| | | | - Marcello Ceppi
- Clinical Epidemiology Unit, IRCCS-Ospedale Policlinico San Martino, Genoa, Italy
| | - Daniela Cervino
- Department of Public Health, Azienda USL di Bologna, Bologna, Italy
| | | | - Stefania Curti
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Marco De Santis
- Department of Environment and Health, Istituto Superiore di Sanità, Roma, Italy
| | - Lucia Fazzo
- Department of Environment and Health, Istituto Superiore di Sanità, Roma, Italy
| | - Ugo Fedeli
- Epidemiological Department, Azienda Zero, Padova, Veneto Region, Italy
| | - Germano Fiorillo
- Unit of Occupational Medicine-Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, Napoli, Italy
| | - Alberto Franchi
- Department of Public Health, Azienda USL di Bologna, Bologna, Italy
| | - Manuela Gangemi
- Unit of Cancer Epidemiology, Regional Operating Center of Piemonte (COR Piemonte), University of Torino and CPO-Piemonte, Torino, Italy
| | - Manuela Giangreco
- Institute for Maternal and Child Health, IRCCS "Burlo Garofolo", Trieste, Italy
| | - Paolo Giorgi Rossi
- Epidemiology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Paolo Girardi
- Department of Environmental Sciences, Informatics and Statistics, Ca' Foscari University of Venice, Venice, Italy
| | - Ferdinando Luberto
- Epidemiology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Stefania Massari
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Italian Workers' Compensation Authority, Rome, Italy
| | - Stefano Mattioli
- Department of Environmental and Preventive Sciences, University of Ferrara, Ferrara, Italy
| | - Simona Menegozzo
- Unit of Occupational Medicine-Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, Napoli, Italy
| | | | - Paola Michelozzi
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | - Enrica Migliore
- Unit of Cancer Epidemiology, Regional Operating Center of Piemonte (COR Piemonte), University of Torino and CPO-Piemonte, Torino, Italy
| | - Lucia Miligi
- Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy
| | - Enrico Oddone
- Department of Public Health, Experimental and Forensic Medicine-University of Pavia, Pavia, Italy
| | - Roberta Pernetti
- Department of Public Health, Experimental and Forensic Medicine-University of Pavia, Pavia, Italy
| | | | - Sara Piro
- Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy
| | | | - Elisa Romeo
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | | | - Stefano Silvestri
- Department of Translational Medicine, Università del Piemonte Orientale and CPO Piemonte, Novara, Italy
| | - Cinzia Storchi
- Epidemiology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Amerigo Zona
- Department of Environment and Health, Istituto Superiore di Sanità, Roma, Italy
| | - Corrado Magnani
- Department of Translational Medicine, Università del Piemonte Orientale and CPO Piemonte, Novara, Italy
| | - Alessandro Marinaccio
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Italian Workers' Compensation Authority, Rome, Italy
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Fazzo L, Minelli G, De Santis M, Ceccarelli E, Iavarone I, Zona A. The Epidemiological Surveillance of Mesothelioma Mortality in Italy as a Tool for the Prevention of Asbestos Exposure. Int J Environ Res Public Health 2023; 20:5957. [PMID: 37297561 PMCID: PMC10252364 DOI: 10.3390/ijerph20115957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 05/17/2023] [Accepted: 05/19/2023] [Indexed: 06/12/2023]
Abstract
As part of a surveillance plan active since the early 1990s, this study evaluates malignant mesothelioma (MM) mortality for the time-window 2010-2019 in Italy, a country that banned asbestos in 1992. National and regional mortality rates for MM, and municipal standardized mortality ratios (all mesotheliomas, pleural (MPM) and peritoneal (MPeM)), by gender and age group were calculated. A municipal clustering analysis was also performed. There were 15,446 deaths from MM (11,161 males, 3.8 × 100,000; 4285 females, 1.1 × 100,000), of which 12,496 were MPM and 661 were MPeM. In the study period, 266 people ≤50 years died from MM. A slightly decreasing rate among males since 2014 was observed. The areas at major risk hosted asbestos-cement plants, asbestos mines (chrysotile in Balangero), shipyards, petrochemical and chemical plants, and refineries. Female mortality excesses particularly were found in municipalities with a fluoro-edenite-contaminated mine (Biancavilla) and textile facilities. Excesses were also found in a region with the presence of natural asbestos fibres and in males living in two small islands. The Italian National Prevention Plan stated recommendations to eliminate asbestos exposures and to implement health surveillance and healthcare for people exposed to asbestos.
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Affiliation(s)
- Lucia Fazzo
- Department of Environment and Health, Istituto Superiore di Sanità, 00161 Rome, Italy; (M.D.S.); (I.I.); (A.Z.)
| | - Giada Minelli
- Statistical Service, Istituto Superiore di Sanità, 00161 Rome, Italy; (G.M.); (E.C.)
| | - Marco De Santis
- Department of Environment and Health, Istituto Superiore di Sanità, 00161 Rome, Italy; (M.D.S.); (I.I.); (A.Z.)
| | - Emiliano Ceccarelli
- Statistical Service, Istituto Superiore di Sanità, 00161 Rome, Italy; (G.M.); (E.C.)
| | - Ivano Iavarone
- Department of Environment and Health, Istituto Superiore di Sanità, 00161 Rome, Italy; (M.D.S.); (I.I.); (A.Z.)
| | - Amerigo Zona
- Department of Environment and Health, Istituto Superiore di Sanità, 00161 Rome, Italy; (M.D.S.); (I.I.); (A.Z.)
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Marsili D, Iavarone I, Pasetto R, Soggiu ME, Fazzo L, Minelli G, Forti M, Unali F, Fabri A, Zona A. [The concept map of SENTIERI Project: a communication interactive digital tool of the national epidemiological surveillance system of Italian contaminated sites]. Epidemiol Prev 2023; 47:385-391. [PMID: 36825381 DOI: 10.19191/ep23.1-2-s1.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
This paper describes the development and the envisioned use of concept maps in the framework of the SENTIERI communication strategies as an information and scientific communication tool applied to epidemiological surveillance in contaminated sites. The concept map of SENTIERI 2019-2022 was designed and implemented to foster access to complex scientific information ensuring usability of the contents and communication with the various stakeholders. The concept map aims to promote environmental health literacy in contaminated sites. The methodology adopted to create the map includes the following phases: 1. choice of a dynamic focus question; 2. selection of the representative terms of the addressed topics; 3. elaboration of the glossary of the selected terms; 4. representation of the links among the selected terms; 5. identification of the significant propositions that make explicit the meaning of each link. Online access to the map is guaranteed by the Mindomo software. The use of the concept map promotes active learning of the topics that characterize SENTIERI 2019-2022 through knowledge paths chosen because of the specific interests and learning purposes. The concept map derives from the integration of specific approaches of the epidemiological discipline with those of the social sciences and offers the possibility of developing site-specific maps through the interactions with local actors and the integration of elements related to emerging problems as well as institutional and local interests.
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Affiliation(s)
- Daniela Marsili
- Dipartimento ambiente e salute, Istituto superiore di sanità, Roma.,WHO Collaborating Centre for Environmental Health in Contaminated Sites, Istituto superiore di sanità, Roma;
| | - Ivano Iavarone
- Dipartimento ambiente e salute, Istituto superiore di sanità, Roma.,WHO Collaborating Centre for Environmental Health in Contaminated Sites, Istituto superiore di sanità, Roma
| | - Roberto Pasetto
- Dipartimento ambiente e salute, Istituto superiore di sanità, Roma.,WHO Collaborating Centre for Environmental Health in Contaminated Sites, Istituto superiore di sanità, Roma
| | | | - Lucia Fazzo
- Dipartimento ambiente e salute, Istituto superiore di sanità, Roma.,WHO Collaborating Centre for Environmental Health in Contaminated Sites, Istituto superiore di sanità, Roma
| | - Giada Minelli
- Servizio di statistica, Istituto superiore di sanità, Roma
| | | | | | - Alessandra Fabri
- Dipartimento ambiente e salute, Istituto superiore di sanità, Roma.,WHO Collaborating Centre for Environmental Health in Contaminated Sites, Istituto superiore di sanità, Roma
| | - Amerigo Zona
- Dipartimento ambiente e salute, Istituto superiore di sanità, Roma.,WHO Collaborating Centre for Environmental Health in Contaminated Sites, Istituto superiore di sanità, Roma
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Stoppa G, Minelli G, Manno V, Ceccarelli E, Pasetto R, Fazzo L, Iavarone I, Biggeri A, Catelan D. [Methodological approaches to evaluate the over-time mortality in SENTIERI epidemiological surveillance system: a focus on cohort analyses]. Epidemiol Prev 2023; 47:354-365. [PMID: 36825378 DOI: 10.19191/ep23.1-2-s1.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
The SENTIERI Project analyses the health profile of the populations residing in Italian national priority contaminated sites in specific calendar periods using a cross-sectional approach. An aspect that has not been evaluated so far is the analysis over a long period, for understanding the changes in health profiles over time and studying them also in function of the changes occurred in the territories. This article studies temporal trends by birth cohort and calendar period for overall mortality and lung cancer mortality from 1980 to 2018, separately for men and women, for three sites: Priolo (Sicily Region, Southern Italy), Pitelli (Liguria Region, Northern Italy), and Terni-Papigno (Umbria Region, Central Italy). A method for selecting the temporal model that best fits the data is then proposed. General mortality presents complex temporal profiles when considering cumulative risks, and usually the most important temporal axis is the birth cohort for cumulative SMRs (i.e., after adjusting for trends in the reference population). For lung cancer, the most important time axis is the birth cohort and the age-cohort model is the most appropriate, in particular for men of Priolo and Terni.
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Affiliation(s)
- Giorgia Stoppa
- Unità di biostatistica, epidemiologia e sanità pubblica, Dipartimento di scienze cardio-toraco vascolari e sanità pubblica, Università di Padova
| | - Giada Minelli
- Servizio di statistica, Istituto superiore di sanità, Roma
| | - Valerio Manno
- Servizio di statistica, Istituto superiore di sanità, Roma
| | - Emiliano Ceccarelli
- Dipartimento di scienze statistiche, Università degli studi di Roma "Sapienza", Roma
| | - Roberto Pasetto
- Dipartimento ambiente e salute, Istituto superiore di sanità, Roma
| | - Lucia Fazzo
- Dipartimento ambiente e salute, Istituto superiore di sanità, Roma
| | - Ivano Iavarone
- Dipartimento ambiente e salute, Istituto superiore di sanità, Roma
| | - Annibale Biggeri
- Unità di biostatistica, epidemiologia e sanità pubblica, Dipartimento di scienze cardio-toraco vascolari e sanità pubblica, Università di Padova
| | - Dolores Catelan
- Unità di biostatistica, epidemiologia e sanità pubblica, Dipartimento di scienze cardio-toraco vascolari e sanità pubblica, Università di Padova;
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Zona A, Fazzo L, Benedetti M, Bruno C, Vecchi S, Pasetto R, Minichilli F, De Santis M, Nannavecchia AM, Di Fonzo D, Contiero P, Ricci P, Bisceglia L, Manno V, Minelli G, Santoro M, Gorini F, Ancona C, Scondotto S, Soggiu ME, Scaini F, Beccaloni E, Marsili D, Villa MF, Maifredi G, Magoni M, Iavarone I. [SENTIERI - Epidemiological Study of Residents in National Priority Contaminated Sites. Sixth Report]. Epidemiol Prev 2023; 47:1-286. [PMID: 36825373 DOI: 10.19191/ep23.1-2-s1.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
INTRODUCTION ADN OBJECTIVES The Sixth Report presents the results of the "SENTIERI Project: implementation of the permanent epidemiological surveillance system of populations residing in Italian Sites of Remediation Interest", promoted and financed by the Italian Ministry of Health (Centre for Disease Control and Prevention - CCM Project 2018). The aim of this study is to update the mortality and hospitalization analyses concerning the 6,227,531 inhabitants (10.4% of the Italian population) residing in 46 contaminated sites (39 of national interest and 7 of regional interest). The sites include 316 municipalities distributed as follows: 15 in the North-East (20.3% of the investigated population); 104 in the North-West (12% of the investigated population), 32 in the Centre (12.6% of the investigated population), 165 in the South and Islands (55.5% of the investigated population). Analyses were carried out on the paediatric-adolescent (1,128,396 residents) and youth (665,284 residents) population, and a study on congenital anomalies (CA) was carried out at sites covered by congenital malformation registers. Accompanying the epidemiological assessments, site-specific socioeconomic conditions were examined and an overall estimate of excess risk for populations residing at contaminated sites was drawn up. By means of a systematic review of the scientific literature, the epidemiological evidence on causal links between sources of environmental exposure and health effects was updated to identify pathologies of a priori interest. METHODOLOGY In the 46 sites included in the SENTIERI Project, mortality (time window: 2013-2017) and hospital admissions (time window: 2014-2018) of the general population of all ages, divided by gender, and of the paediatric-adolescent (0-1 year, 0-14 years, 0-19 years), youth (20-29 years), and overall (0-29 years) age groups, divided by gender, were analysed. In 21 sites, CA diagnosed within the first year of life were studied. Standardised mortality ratios (SMR) and hospitalization ratios (SHR) were calculated with reference to the rates in the regions to which the sites belong. The reference population was calculated net of residents in the sites. CA were studied by calculating the prevalence per 10,000 births and the ratio, multiplied by 100, between the cases observed at the site and those expected on the basis of the prevalences observed in the reference area (region or sub-regional area of belonging, according to the geographical coverage of the registry). The socioeconomic condition studied in the 46 sites is based on the convergence of three deprivation indicators with respect to the reference region: deprivation index at municipal level, deprivation index at census section level, premature mortality indicator (age range 30-69 years) for chronic non-communicable diseases. For the estimation of excess risk for the entire study population, meta-analysis of the mortality and hospitalization risk estimates for each site was carried out and the number of excess deaths estimated for the sites as a whole. The epidemiological evidence was updated through a systematic literature review (January 2009-May 2020), following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The search was carried out on the search engines MEDLINE, EMBASE and Web of Science; the quality of the studies included in the review was assessed using the AMSTAR 2 checklist for systematic reviews and the NewCastle-Ottawa Scale for observational studies in the case of cohort and case-control studies and a modified version thereof for ecological and cross-sectional studies. The update was based on the selection of 14 systematic reviews, 15 primary studies, 6 monographs/reports from international scientific organisations on health effects due to the presence of environmental exposure sources. RESULTS Mortality. The a priori causes of interest that occur most frequently in excess are, in descending order: malignant lung cancer, malignant mesothelioma of the pleura, malignant bladder cancer, respiratory diseases, non-Hodgkin lymphomas, malignant liver cancer, all malignant tumours, malignant colorectal cancer, malignant stomach cancer, total mesotheliomas, malignant breast cancer, and asbestosis. Hospitalization. The a priori causes of interest that occur most frequently in excess are represented in descending order by: respiratory diseases, malignant lung cancer, malignant tumours of the pleura, malignant bladder cancer, malignant breast cancer, malignant liver cancer, asthma, malignant colorectal cancer, all malignant tumours, malignant stomach cancer, non-Hodgkin's lymphomas, acute respiratory diseases, leukaemias. The differences observed between mortality and hospitalization can be attributed to the intrinsic characteristics of the diseases (higher or lower lethality, gender differences in incidence), lifestyles, and occupational phenomena. Age classes. Excesses of general mortality were observed in the first year of life at the Manfredonia, Basso Bacino Fiume Chienti, Litorale Domizio Flegreo and Agro Aversano sites; in the 0-1 year and 0-19 year age groups at Casale Monferrato; in the paediatric age group at Serravalle Scrivia and at the Trento Nord site; in the 0-19 year age group at Sassuolo Scandiano; in the young age group (0-29 years) at the two municipalities of Cerchiara and Cassano (Crotone-Cassano-Cerchiara site). With regard to hospitalization due to natural causes, risk excesses in both genders are found in the first year of life in 35% of the sites (Porto Torres industrial areas, Bari-Fibronit, Basso bacino fiume Chienti, Bolzano, Crotone-Cassano-Cerchiara, Cerro al Lambro, Bologna ETR large repair workshop, Gela, Manfredonia, Massa Carrara, Pioltello Rodano, Pitelli, Priolo, Sesto San Giovanni, Trento Nord, and Trieste). These same sites, with the addition of Casale Monferrato, Cengio e Saliceto, Serravalle Scrivia, and Sulcis-Iglesiente-Guspinese (total: 43% of sites), show excesses for all natural causes, in both genders, even in the paediatric-adolescent age group (0-19 years). Among young adults (20-29 years), the analyses show excesses of hospitalization for all natural causes in both genders in the Bolzano, Crotone-Cassano-Cerchiara, Gela, Manfredonia, Pitelli, Priolo, and Sulcis-Iglesiente-Guspinese sites. Among young women only, excesses for all natural causes are also found in Brescia Caffaro, Brindisi, Broni, Casale Monferrato, Crotone-Cassano-Cerchiara, Falconara Marittima, Fidenza, and Massa Carrara. Congenital anomalies. In the 21 sites investigated for CA, 10,126 cases of CA, validated by participating registers, were analysed out of 304,620 resident births. Genital CA is the subgroup for which the greatest number of excesses was observed (in 6 out of 21 sites). The available evidence does not allow a causal link to be established between the excesses observed for specific subgroups of ACs and exposure to industrial sources, but the results suggest further action. The interpretation of the results appears, in fact, particularly complex as the scientific literature on the association between exposure to industrial sources and AC is very limited. Socioeconomic status. The sites in which the indicators converge to show the presence of fragility are: Litorale Vesuviano area, Val Basento industrial areas, Basso Bacino fiume Chienti, Biancavilla, Crotone-Cassano-Cerchiara, Litorale Domizio Flegreo and Agro Aversano, Livorno, Massa Carrara, Trieste. Global impact. Over the period 2013-2017, an estimated 8,342 excess deaths (CI90% 1,875-14,809) or approximately 1,668 excess cases/year, 4,353 excess deaths among males (CI90% 334-8,372) and 3,989 among females (CI90% -1,122;9,101). The pooled excess risk of general mortality is 2% in both genders (pooled SMR 1.02; CI90% 1.00-1.04). The proportion of excess deaths to total observed deaths is almost constant over time, rising from 2.5% in 1995-2002 to 2.6% in 2013-2017. The number of deaths in absolute value is also very similar between the periods analysed. Deaths from all malignant tumours contribute the most by accounting for 56% of the observed excesses, the excess risk of mortality from malignant tumours across all sites, compared to the reference populations, is 4% in the male population (pooled SMR 1.04; CI90% 1.01-1.06) and 3% among the female population (pooled SMR 1.03; CI90% 1.01-1.05). Hospitalization (2014-2018) in the 46 sites as a whole was in excess of 3% for all causes, in both genders, for all major disease groups (males: SHR pooled 1.03; CI90% 1.01-1.04 - females: SHR pooled 1.03; CI90% 1.01-1.05). The results for the pooled estimates at the 46 sites on the general population, both with regard to mortality and hospitalization, are consistent in indicating excess risk in both genders for all the diseases considered and, in particular, for all malignancies. A total of 1,409 paediatric-adolescent deaths and 999 young adult deaths were observed, and the pooled analysis of mortality across the 46 sites showed no critical issues, with pooled estimates for all causes, perinatal morbid conditions and all malignancies falling short of expectations. The analysis of hospitalizations, on the other hand, showed an excess risk of 8% (males: SHR pooled 1.08; CI90% 1.03-1.13 - females: SHR pooled 1.08; CI90% 1.03-1.14) for all causes in the first year of life, and in paediatric-adolescent and juvenile age of 3-4% among males (age 0-19 years: SHR pooled 1.04; CI90% 1.02-1.06 - age 20-29 years: SHR pooled 1.03; CI90% 1.00-1.05) and 5% among females (in both age groups; SHR pooled 1.05; CI90% 1.02-1.08). The pooled analysis of mortality for the a priori identified diseases reported excesses for specific diseases in the group of sites with sources of exposure associated with them. Mortality from total mesotheliomas is three times higher at sites with asbestos present (males: pooled SMR 3.02; CI90% 2.18-3.87 - females: pooled SMR 3.61; CI90% 2.33-4.88) and that from pleural mesotheliomas more than two times higher at the group of sites with asbestos and port areas (males: pooled SMR 2.47; CI90% 1.94-3.00 - females: pooled SMR 2.43; CI90% 1.67-3.19). Lung cancer was in excess by 6% among males (pooled SMR 1.06; CI90% 1.03-1.10) and 7% among females (pooled SMR 1.07; CI90% 1.00-1.13). In addition, there are excess mortalities for colorectal cancer at sites with chemical plants, by 4 % among males (SMR pooled 1.04; CI90% 1.01-1.08) and 3 % among females (SMR pooled 1.03; CI90% 1.00-1.07) and for bladder cancer among the male population of sites with landfills (+6 %: SMR pooled 1.06; CI90% 1.02-1.11). Among the diseases of a priori interest, stomach and soft tissue cancers are at fault as a cause of death among all the sites considered. LITERATURE REVIEW The update of the epidemiological evidence underlying the Sixth SENTIERI Report has highlighted in the general population a possible association, previously undiscovered, between certain diseases and residence near petrochemical and steel plants, landfills, coal mines and asbestos sources. CONCLUSIONS AND PERSPECTIVES Despite the fact that this is an ecological study, and the excesses of pathologies with multifactorial aetiology can never be mechanically attributed solely to the environmental pressure factors that exist or existed in the areas studied, the ability to identify the excesses found in the contaminated sites investigated by the SENTIERI Project confirms the validity of this method of assessing the site-specific health profile, based on the use of epidemiological evidence to identify pathologies of interest a priori. In interpreting the data and lending robustness to what has been observed, comparison with the results obtained in previous Reports is essential. The global estimates give an overall picture that shows excess mortality and hospitalization in these populations compared to the rest of the population, and show how, for specific pathologies, comparable effects are produced at sites with similar contamination characteristics. The themes developed in the in-depth chapters broaden the vision and understanding of the complex interactions between environment and health, describe the possibilities offered by new ways of communicating the results, and confirm the modernity of a Project that began way back in 2006, and that could be grafted onto the objectives of the National Recovery and Resilience Plan within the framework of the Operational Programme Health, Environment, Biodiversity and Climate.
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Affiliation(s)
- Amerigo Zona
- Dipartimento ambiente e salute, Istituto superiore di sanità, Roma; .,WHO Collaborating Centre for Environmental Health in Contaminated Sites, Istituto superiore di sanità, Roma
| | - Lucia Fazzo
- Dipartimento ambiente e salute, Istituto superiore di sanità, Roma.,WHO Collaborating Centre for Environmental Health in Contaminated Sites, Istituto superiore di sanità, Roma
| | - Marta Benedetti
- Dipartimento ambiente e salute, Istituto superiore di sanità, Roma.,WHO Collaborating Centre for Environmental Health in Contaminated Sites, Istituto superiore di sanità, Roma
| | - Caterina Bruno
- già Dipartimento ambiente e salute, Istituto superiore di sanità, Roma.,già WHO Collaborating Centre for Environmental Health in Contaminated Sites, Istituto superiore di sanità, Roma
| | - Simona Vecchi
- Dipartimento di epidemiologia del Servizio sanitario regionale, Regione Lazio, ASL Roma 1, Roma
| | - Roberto Pasetto
- Dipartimento ambiente e salute, Istituto superiore di sanità, Roma.,WHO Collaborating Centre for Environmental Health in Contaminated Sites, Istituto superiore di sanità, Roma
| | - Fabrizio Minichilli
- Unità di ricerca di epidemiologia ambientale e registri di patologia, Istituto di fisiologia clinica, Consiglio nazionale delle ricerche, Pisa
| | - Marco De Santis
- Dipartimento ambiente e salute, Istituto superiore di sanità, Roma.,WHO Collaborating Centre for Environmental Health in Contaminated Sites, Istituto superiore di sanità, Roma
| | - Anna Maria Nannavecchia
- Agenzia regionale strategica per la salute e il sociale della Puglia (AReSS Puglia), Bari.,Registro delle malformazioni congenite della Regione Puglia
| | | | - Paolo Contiero
- SS Epidemiologia ambientale, Fondazione IRCCS Istituto nazionale dei tumori, Milano
| | - Paolo Ricci
- già UOC Osservatorio epidemiologico, ATS Val Padana, Mantova
| | - Lucia Bisceglia
- Agenzia regionale strategica per la salute e il sociale della Puglia (AReSS Puglia), Bari.,Registro delle malformazioni congenite della Regione Puglia
| | - Valerio Manno
- Servizio tecnico-scientifico di statistica, Istituto superiore di sanità, Roma
| | - Giada Minelli
- Servizio tecnico-scientifico di statistica, Istituto superiore di sanità, Roma
| | - Michele Santoro
- Unità di epidemiologia delle malattie rare e delle anomalie congenite, Istituto di fisiologia clinica, Consiglio nazionale delle ricerche, Pisa
| | - Francesca Gorini
- Unità di epidemiologia delle malattie rare e delle anomalie congenite, Istituto di fisiologia clinica, Consiglio nazionale delle ricerche, Pisa
| | - Carla Ancona
- Dipartimento di epidemiologia del Servizio sanitario regionale, Regione Lazio, ASL Roma 1, Roma
| | - Salvatore Scondotto
- già Dipartimento per le attività sanitarie e osservatorio epidemiologico, Assessorato della salute, Regione Siciliana.,già Sistema di sorveglianza sulle malformazioni congenite, Regione Sicilia
| | | | - Federica Scaini
- Dipartimento ambiente e salute, Istituto superiore di sanità, Roma
| | | | - Daniela Marsili
- Dipartimento ambiente e salute, Istituto superiore di sanità, Roma.,WHO Collaborating Centre for Environmental Health in Contaminated Sites, Istituto superiore di sanità, Roma
| | - Marco Francesco Villa
- UOC Osservatorio epidemiologico, ATS Val Padana, Mantova.,Registro malformazioni congenite della Provincia di Mantova
| | | | - Michele Magoni
- già UO Osservatorio epidemiologico, ATS Brescia, Brescia
| | - Ivano Iavarone
- Dipartimento ambiente e salute, Istituto superiore di sanità, Roma.,WHO Collaborating Centre for Environmental Health in Contaminated Sites, Istituto superiore di sanità, Roma
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Vecchi S, Benedetti M, Fazzo L, Bruno C, Zona A. [SENTIERI Project: a systematic review on the association between sources of environmental exposure in contaminated sites and health outcomes]. Epidemiol Prev 2023; 47:289-309. [PMID: 36825374 DOI: 10.19191/ep23.1-2-s1.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
BACKGROUND the epidemiological surveillance programme carried out in the Italian Contaminated Sites (SENTIERI Project) is based on an a priori evaluation of the epidemiological evidence of a causal association between environmental exposures and health outcomes. OBJECTIVES to produce an updated review of the epidemiological evidence (January 2009-May 2020) on the association between environmental exposures and health outcomes predefined and published by the SENTIERI working group. METHODS a systematic review was conducted on MEDLINE, EMBASE, and Web of Science. Additional searches were conducted on the websites of relevant organizations. The sources of environmental exposure considered were the ones included in SENTIERI Projects (chemicals, petrochemicals and refineries, steel plants, power plants, port area, waste, mines and source of asbestos). RESULTS a total of 16,817 records were identified and, after the screening process, 14 systematic reviews were identified: two IARC Monograph, two WHO Reports, one WHO/UNEP Report, and 15 observational studies. Living in proximity of contaminated sites was associated with specific diseases (mortality or incidence), with a high heterogeneity across environmental sources. For some exposures, data suggests a gender differential effect for some causes of disease. CONCLUSIONS compared to a previous evidence evaluation, this systematic review shows a higher number of diseases associated with residential exposure to some contaminated sites (petrochemical facilities, waste, mines, and sources of asbestos). According to the results of this review, the a priori evidence evaluation was updated and used to interpret the epidemiological data of the Sixth SENTIERI Project Report.
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Affiliation(s)
- Simona Vecchi
- Dipartimento di epidemiologia del Servizio sanitario regionale, Regione Lazio, ASL Roma 1, Roma;
| | - Marta Benedetti
- Dipartimento ambiente e salute, Istituto superiore di sanità, Roma.,WHO Collaborating Centre for Environmental Health in Contaminated Sites, Istituto superiore di sanità, Roma
| | - Lucia Fazzo
- Dipartimento ambiente e salute, Istituto superiore di sanità, Roma.,WHO Collaborating Centre for Environmental Health in Contaminated Sites, Istituto superiore di sanità, Roma
| | - Caterina Bruno
- già Dipartimento ambiente e salute, Istituto superiore di sanità, Roma.,già WHO Collaborating Centre for Environmental Health in Contaminated Sites, Istituto superiore di sanità, Roma
| | - Amerigo Zona
- Dipartimento ambiente e salute, Istituto superiore di sanità, Roma.,WHO Collaborating Centre for Environmental Health in Contaminated Sites, Istituto superiore di sanità, Roma
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Fazzo L, Manno V, Iavarone I, Minelli G, De Santis M, Beccaloni E, Scaini F, Miotto E, Airoma D, Comba P. The health impact of hazardous waste landfills and illegal dumps contaminated sites: An epidemiological study at ecological level in Italian Region. Front Public Health 2023; 11:996960. [PMID: 36923045 PMCID: PMC10010672 DOI: 10.3389/fpubh.2023.996960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 01/26/2023] [Indexed: 03/03/2023] Open
Abstract
Background and aim The implementation of idoneous management of hazardous waste, in contrast to illegal practices, is one of the environment and health priorities of the WHO. The aim of the present study, based on a collaborative agreement between the Italian National Health Institute and a Prosecution Office located in Naples North, was to evaluate the health effects of illegal landfills and burning of urban and hazardous waste in the territory of the Prosecution Office. Methods The municipalities included in the study territory were investigated with respect to the regional population. Regression analyses were performed in the study area between four classes of an environmental municipal indicator of waste risk (MRI) previously defined, computing the relative risks (RRs) in 2-4 MRI classes, with respect to the first MRI class (the least impacted). The prevalence of reproductive outcomes and cause-specific mortality and hospitalization were analyzed in the general population and in the 0-19-year-old population using SAS software. Results An increase of mortality and hospitalization risk in both the genders of the whole area, with respect to regional population, were found for overall all cancer cases, cancer of the stomach, the liver, the lung and the kidney, and ischemic heart diseases. An increase of mortality for leukemias in the 0-19-year-old population and in hospitalization risk for certain conditions originating in the perinatal period were observed. Correlation between MRI and the risk of mortality from breast tumors in women (MRI class 2: RR = 1.06; MRI class 3: RR = 1.15; MRI class 4: RR = 1.11) and between MRI and the risk of hospitalization from testis tumors (MRI class 2: RR = 1.25; MRI class 3: RR = 1.31; MRI class 4: RR = 1.32) were found. The hospitalization risk from breast tumors and asthma exceeded significantly in both genders of three and four MRI classes. Among the 0-19-year-old population, correlation between MRI and hospitalization from leukemias (MRI class 2: RR = 1.48; MRI class 3: RR = 1.60; MRI class 4: RR = 1.41) and between MRI and the prevalence of preterm birth (MRI class 2: RR = 1.17; MRI class 3: RR = 1.08; MRI class 4: RR = 1.25) were found. Conclusion A correlation between health outcomes and the environmental pressure by uncontrolled waste sites was found. Notwithstanding the limitation of the study, the results promote implementing the actions of environmental remediation and the prosecution of illegal practices.
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Affiliation(s)
- Lucia Fazzo
- Department of Environment and Health, Istituto Superiore di Sanità, Rome, Italy.,World Health Organization Collaborating Centre for Environmental Health in Contaminated Sites, Rome, Italy
| | - Valerio Manno
- Statistical Service, Istituto Superiore di Sanità, Rome, Italy
| | - Ivano Iavarone
- Department of Environment and Health, Istituto Superiore di Sanità, Rome, Italy.,World Health Organization Collaborating Centre for Environmental Health in Contaminated Sites, Rome, Italy
| | - Giada Minelli
- Statistical Service, Istituto Superiore di Sanità, Rome, Italy
| | - Marco De Santis
- Department of Environment and Health, Istituto Superiore di Sanità, Rome, Italy.,World Health Organization Collaborating Centre for Environmental Health in Contaminated Sites, Rome, Italy
| | - Eleonora Beccaloni
- Department of Environment and Health, Istituto Superiore di Sanità, Rome, Italy
| | - Federica Scaini
- Department of Environment and Health, Istituto Superiore di Sanità, Rome, Italy
| | - Edoardo Miotto
- Department of Medicine, University of Udine, Udine, Italy
| | - Domenico Airoma
- Avellino Prosecution Office, Former North Naples Prosecution Office, Avellino, Italy
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Fazzo L, Minichilli F, Manno V, Iavarone I, Benedetti M, Contiero P, Maraschini A, Minelli G, Pasetto R, Ricci P. [Global evaluation of the mortality and hospitalization in the Italian contaminated sites included in the SENTIERI project]. Epidemiol Prev 2023; 47:366-374. [PMID: 36825379 DOI: 10.19191/ep23.1-2-s1.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
Since 2006, epidemiological surveillance of populations living in Italian contaminated sites has been ongoing (SENTIERI Project). Updated global estimates of mortality (2013-2017) and hospitalization (2014-2018) are reported. The excess deaths (observed-expected) for the main groups of diseases were calculated for all the 46 sites together. Through a random-effect meta-analysis of the standardized mortality and hospitalization rates (SMR/SHR), the pooled SMR/SHR for all the sites and their groupings were estimated. In the 46 sites, 8,342 exceeding deaths (1,668/year) were estimated, 4,353 in males and 3,989 in females, resulting in an excess risk of 2% in both genders. The risk of hospitalization for all causes was in excess of 3%. These excesses are mainly attributable to malignant tumours. In subgroups of sites, exceeding SMRs were observed for all mesotheliomas and pleural mesotheliomas, lung and colorectal cancers in both genders. SHR for all causes were observed in excess in the first year of life (+8%), in the group 0-19 and 20-29 years (+3-5%); no excesses of mortality were observed in the group 0-29 years.
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Affiliation(s)
- Lucia Fazzo
- Dipartimento ambiente e salute, Istituto superiore di sanità, Roma; .,WHO Collaborating Centre for Environmental Health in Contaminated Sites, Istituto superiore di sanità, Roma
| | - Fabrizio Minichilli
- Unità di ricerca di epidemiologia ambientale e registri di patologia, Istituto di fisiologia clinica, Consiglio nazionale delle ricerche, Pisa
| | - Valerio Manno
- Servizio di statistica, Istituto superiore di sanità, Roma
| | - Ivano Iavarone
- Dipartimento ambiente e salute, Istituto superiore di sanità, Roma.,WHO Collaborating Centre for Environmental Health in Contaminated Sites, Istituto superiore di sanità, Roma
| | - Marta Benedetti
- Dipartimento ambiente e salute, Istituto superiore di sanità, Roma.,WHO Collaborating Centre for Environmental Health in Contaminated Sites, Istituto superiore di sanità, Roma
| | - Paolo Contiero
- Unità di epidemiologia ambientale, Fondazione IRCCS Istituto nazionale dei tumori, Milano
| | | | - Giada Minelli
- Servizio di statistica, Istituto superiore di sanità, Roma
| | - Roberto Pasetto
- Dipartimento ambiente e salute, Istituto superiore di sanità, Roma.,WHO Collaborating Centre for Environmental Health in Contaminated Sites, Istituto superiore di sanità, Roma
| | - Paolo Ricci
- già UOC Osservatorio epidemiologico, ATS Val Padana, Mantova
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Stoppa G, Mensi C, Fazzo L, Minelli G, Manno V, Consonni D, Biggeri A, Catelan D. Spatial Analysis of Shared Risk Factors between Pleural and Ovarian Cancer Mortality in Lombardy (Italy). Int J Environ Res Public Health 2022; 19:ijerph19063467. [PMID: 35329152 PMCID: PMC8949464 DOI: 10.3390/ijerph19063467] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 03/11/2022] [Accepted: 03/12/2022] [Indexed: 01/04/2023]
Abstract
Background: Asbestos exposure is a recognized risk factor for ovarian cancer and malignant mesothelioma. There are reports in the literature of geographical ecological associations between the occurrence of these two diseases. Our aim was to further explore this association by applying advanced Bayesian techniques to a large population (10 million people). Methods: We specified a series of Bayesian hierarchical shared models to the bivariate spatial distribution of ovarian and pleural cancer mortality by municipality in the Lombardy Region (Italy) in 2000–2018. Results: Pleural cancer showed a strongly clustered spatial distribution, while ovarian cancer showed a less structured spatial pattern. The most supported Bayesian models by predictive accuracy (widely applicable or Watanabe–Akaike information criterion, WAIC) provided evidence of a shared component between the two diseases. Among five municipalities with significant high standardized mortality ratios of ovarian cancer, three also had high pleural cancer rates. Wide uncertainty was present when addressing the risk of ovarian cancer associated with pleural cancer in areas at low background risk of ovarian cancer. Conclusions: We found evidence of a shared risk factor between ovarian and pleural cancer at the small geographical level. The impact of the shared risk factor can be relevant and can go unnoticed when the prevalence of other risk factors for ovarian cancer is low. Bayesian modelling provides useful information to tailor epidemiological surveillance.
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Affiliation(s)
- Giorgia Stoppa
- Unit of Biostatistics, Epidemiology and Public Health, DCTVPH, University of Padova, 35131 Padova, Italy; (A.B.); (D.C.)
- Correspondence: (G.S.); (C.M.)
| | - Carolina Mensi
- Occupational Health Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy;
- Correspondence: (G.S.); (C.M.)
| | - Lucia Fazzo
- Department of Environment and Health, Istituto Superiore di Sanità, 00100 Rome, Italy;
| | - Giada Minelli
- Statistical Service, Istituto Superiore di Sanità, 00100 Roma, Italy; (G.M.); (V.M.)
| | - Valerio Manno
- Statistical Service, Istituto Superiore di Sanità, 00100 Roma, Italy; (G.M.); (V.M.)
| | - Dario Consonni
- Occupational Health Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy;
| | - Annibale Biggeri
- Unit of Biostatistics, Epidemiology and Public Health, DCTVPH, University of Padova, 35131 Padova, Italy; (A.B.); (D.C.)
| | - Dolores Catelan
- Unit of Biostatistics, Epidemiology and Public Health, DCTVPH, University of Padova, 35131 Padova, Italy; (A.B.); (D.C.)
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Benedetti M, Minichilli F, Soggiu ME, Manno V, Fazzo L. Ecological meta-analytic study of kidney disease in Italian contaminated sites. Ann Ist Super Sanita 2021; 57:314-323. [PMID: 35076421 DOI: 10.4415/ann_21_04_06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Environmental heavy metals exposure has been associated with kidney disease. There is also some evidence that exposure to solvents may be a risk factor for kidney disease. We estimated the risk of hospitalization for kidney diseases (ICD-9 580-586) and chronic kidney disease (CDK, ICD-9 585) in residents in thirty-four Italian National Priority Contaminated Sites (NPCSs) polluted by heavy metals. METHODS Random-effects model meta-analyses of SHR (Standard Hospitalization Ratio) computed for each NPCS was performed for all the NPCSs together, and separately, according to the presence/absence of selected industrial activities (petrochemical/refinery and steel plants), and the presence/absence of solvents contamination. RESULTS Pooled SHRs of overall NPCSs were in excess in both genders. Statistically significant excesses were found for CKD in both genders, and for kidney diseases in females, residing in NPCSs with the combined presence of heavy metals and solvents contamination. The pooled SHRs for CKD and kidney diseases were not statistically significant in excess in NPCSs with petrochemical/refinery and steel plants, and only petrochemical/refinery plants. CONCLUSIONS The results are suggestive of a possible kidney disease risk in population living in the above-mentioned NPCSs. Epidemiological surveillance and remediation actions in these areas are recommended.
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Affiliation(s)
- Marta Benedetti
- Dipartimento Ambiente e Salute, Istituto Superiore di Sanità, Rome, Italy
| | - Fabrizio Minichilli
- Unità di Ricerca di Epidemiologia Ambientale e Registri di Patologia, Istituto di Fisiologia Clinica, Consiglio Nazionale delle Ricerche (CNR), Pisa, Italy
| | | | - Valerio Manno
- Servizio di Statistica, Istituto Superiore di Sanità, Rome, Italy
| | - Lucia Fazzo
- Dipartimento Ambiente e Salute, Istituto Superiore di Sanità, Rome, Italy
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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. Int J Environ Res Public Health 2021; 18:10012. [PMID: 34639316 PMCID: PMC8508095 DOI: 10.3390/ijerph181910012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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Barone Adesi F, Bruno C, Calisti R, Chellini E, Comba P, Consonni D, Fazzo L, Fedeli U, Forastiere F, Magnani C, Marinaccio A, Merler E, Mirabelli D, Ricci P, Terracini B. [Effects of Asbestos on Human Health. Document of the Italian Epidemiological Association (AIE)]. Epidemiol Prev 2021; 44:327-338. [PMID: 33506658 DOI: 10.19191/ep20.5-6.a001.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES the Italian Epidemiological Association (AIE) intends to formulate assessments and recommendations on the most relevant and critical aspects in the preparation, conduct, and interpretation of epidemiological investigations on the health effects of exposure to asbestos and asbestos-like fibres. DESIGN, SETTING, AND PARTICIPANTS the document was prepared by a working group of AIE associates, with a broad curriculum of epidemiological investigations, starting from the evaluation of scientific evidence, and was subsequently evaluated by the AIE governing body. RESULTS the topics covered included: • consumption and presence of asbestos; • association between asbestos exposure and disease; • epidemiological surveillance of asbestos related diseases in Italy; • risk function for asbestos related diseases; • increased risk and anticipation of the disease; • interaction between asbestos and other carcinogens; • diagnosis in epidemiological studies; • assessment of exposure to asbestos; • epidemiological evidence on asbestos related diseases. CONCLUSIONS the document ends with a summary of the conclusions of scientific research shared by AIE, with reflection on the methodology to be followed for the application at individual level of the results of epidemiological studies, and the proposal of themes on which to direct research.
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Affiliation(s)
| | - Caterina Bruno
- Dipartimento ambiente e salute, Istituto superiore di sanità, Roma
| | - Roberto Calisti
- Servizio prevenzione e sicurezza negli ambienti di lavoro - epidemiologia occupazionale, ASUR MARCHE, Civitanova Marche (MC)
| | - Elisabetta Chellini
- SS epidemiologia dell'ambiente e del lavoro, Istituto per lo studio, la prevenzione e la rete oncologica (ISPRO), Firenze
| | - Pietro Comba
- già Direttore, Reparto di epidemiologia ambientale e sociale, Dipartimento ambiente e salute, Istituto superiore di sanità
| | - Dario Consonni
- UO epidemiologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano
| | - Lucia Fazzo
- Dipartimento ambiente e salute, Istituto superiore di sanità, Roma
| | - Ugo Fedeli
- Servizio epidemiologico regionale e registri - Azienda Zero, Regione del Veneto
| | | | - Corrado Magnani
- Dipartimento di medicina traslazionale, Università del Piemonte Orientale, Novara;
| | - Alessandro Marinaccio
- Dipartimento di medicina, epidemiologia, igiene del lavoro e ambientale, Istituto per l'assicurazione contro gli infortuni sul lavoro, Roma
| | - Enzo Merler
- Registro regionale veneto dei casi di mesotelioma, Padova (ora in pensione)
| | - Dario Mirabelli
- Epidemiologia dei tumori, CPO Piemonte e Università di Torino (ora in pensione)
| | - Paolo Ricci
- UOC osservatorio epidemiologico, ATS della Val Padana, Mantova
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Fazzo L, Minelli G, Bruno C, Comba P, Conti S, De Santis M, Zona A, Binazzi A, Magnani C, Marinaccio A, Iavarone I. Early mortality from malignant mesothelioma in Italy as a proxy of environmental exposure to asbestos in children. Ann Ist Super Sanita 2020; 56:478-486. [PMID: 33346174 DOI: 10.4415/ann_20_04_10] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Malignant mesothelioma (MM) is a rare neoplasm caused by asbestos. Mortality from MM in ≤50 years old people, considering the long latency, is likely related to asbestos exposure in childhood. Mortality from MM (C45, ICD10 code) is described among ≤50 years (ys) old people in Italy, in 2003-2016. National and regional Standardized Rates (SRs) were computed by age-class. The North-South trend of regional SRs, increasing in >50ys age-class, showed a flat cline in ≤50ys old people. Municipal Standardized Mortality Ratios (SMRs) were computed, with respect to regional figures, for ≤50 ys old population. In Italy, 487 people ≤50 ys old died from MM, in 2003-2016 (2.5% of all MM deaths), corresponding to 35/year. The highest SMRs were observed in Northern Regions, the most industrialized areas. Exceeding SMRs were found in 10 municipalities where former asbestos-cement plants, shipyards, and a quarry contaminated by fluoro-edenite fibres were present. Early mortality from MM, proxy of childhood environmental asbestos exposure, deserves particular concern.
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Affiliation(s)
- Lucia Fazzo
- Dipartimento di Ambiente e Salute, Istituto Superiore di Sanità, Rome, Italy
| | - Giada Minelli
- Servizio di Statistica, Istituto Superiore di Sanità, Rome, Italy
| | - Caterina Bruno
- Dipartimento di Ambiente e Salute, Istituto Superiore di Sanità, Rome, Italy
| | - Pietro Comba
- Dipartimento di Ambiente e Salute, Istituto Superiore di Sanità, Rome, Italy - Retired
| | - Susanna Conti
- Dipartimento di Ambiente e Salute, Istituto Superiore di Sanità, Rome, Italy - Retired
| | - Marco De Santis
- Dipartimento di Ambiente e Salute, Istituto Superiore di Sanità, Rome, Italy
| | - Amerigo Zona
- Dipartimento di Ambiente e Salute, Istituto Superiore di Sanità, Rome, Italy
| | - Alessandra Binazzi
- Dipartimento di Medicina, Epidemiologia, Igiene del Lavoro e Ambientale, Istituto Nazionale per l'Assicurazione contro gli Infortuni sul Lavoro, Rome, Italy
| | - Corrado Magnani
- Dipartimento di Medicina Traslazionale, Università del Piemonte Orientale, Novara, Italy
| | - Alessandro Marinaccio
- Dipartimento di Medicina, Epidemiologia, Igiene del Lavoro e Ambientale, Istituto Nazionale per l'Assicurazione contro gli Infortuni sul Lavoro, Rome, Italy
| | - Ivano Iavarone
- Dipartimento di Ambiente e Salute, Istituto Superiore di Sanità, Rome, Italy
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Fazzo L, Cernigliaro A, De Santis M, Quattrone G, Bruno C, Zona A, Tumino R, Cascone G, Scondotto S, Comba P. Occupational cohort study of asbestos-cement workers in a contaminated site in Sicily (Italy). Epidemiol Prev 2020; 44:137-144. [PMID: 32631013 DOI: 10.19191/ep20.2-3.p137.036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES to analyse the asbestos-related diseases risk among the former workers of Sacelit asbestos-cement plant, operating in San Filippo del Mela (Sicily: 1958- 1993). DESIGN cohort study. SETTING AND PARTICIPANTS 228 subjects were employed in Sacelit from 1958 to 1993. Due to the available observation periods, the analyses of the different outcomes were performed for the subjects alive at the beginning of the respective follow up periods: mortality (1986-2018) was analysed for 204 subjects (177 men, 27 women), hospitalization (2001-2016) for 164 workers (139 men, 25 women) and the incidence of mesothelioma (1998-2016) was estimated for 178 subjects (153 men, 25 women). MAIN OUTCOMES MEASURES mortality (Standardized Mortality Ratio: SMR) and hospitalization (Standardized Hospitalization Ratio: SHR) from specific diseases were analysed. Incidence (Standardized Incidence Ratio: SIR) of mesothelioma cases was detected, also. SMR (1986-2014), SHR (2001-2016) and SIR (1998-2016), with 95% Confidence Intervals, were computed with respect to the regional rates, with STATA11. RESULTS in the men cohort, mortality from lung (17 cases, SMR 2.83) and pleural cancers (5 cases, SMR 30) and from asbestosis (15 cases, SMR 1,930) was in excess. The risk of hospitalization was in excess, in both genders, from lung cancer (men: 6 cases, SHR 4.1; women: 2 cases, SHR 8.6) and asbestosis (men: 17 cases, SHR 1,304; women: 6 cases, SHR 2,455). The incidence of mesothelioma was in excess in men (5 cases, SIR 23.9); no female cases of mesothelioma were observed. CONCLUSIONS a high occurrence of asbestos-related diseases in the cohort, particularly among men, was observed. The excess of hospitalization from asbestosis and lung cancer was highlighted also in women. The prosecution of the on-going health surveillance plan is particularly appropriated.
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Affiliation(s)
- Lucia Fazzo
- Department of Environment and Health, Istituto Superiore di Sanità, Rome (Italy);
| | - Achille Cernigliaro
- Department of Health Services and Epidemiological Observatory, Regional Health Authority, Sicilian Region, Palermo (Italy)
| | - Marco De Santis
- Department of Environment and Health, Istituto Superiore di Sanità, Rome (Italy)
| | | | - Caterina Bruno
- Department of Environment and Health, Istituto Superiore di Sanità, Rome (Italy)
| | - Amerigo Zona
- Department of Environment and Health, Istituto Superiore di Sanità, Rome (Italy)
| | - Rosario Tumino
- Cancer Registry and Histopathology Unit, Provincial Health Unit, Ragusa (Italy)
| | | | - Salvatore Scondotto
- Department of Health Services and Epidemiological Observatory, Regional Health Authority, Sicilian Region, Palermo (Italy)
| | - Pietro Comba
- Department of Environment and Health, Istituto Superiore di Sanità, Rome (Italy)
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Benedetti M, Fazzo L, Guarda L, Gatti L, Comba P, Ricci P. Residential proximity to an industrial incinerator and risk of soft-tissue sarcoma, 1999-2014. Epidemiol Prev 2020; 44:128-136. [PMID: 32631012 DOI: 10.19191/ep20.2-3.p128.035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND exposure to dioxins has been associated with an increased risk of soft-tissue sarcoma (STS). In a study relating to 1989-1998, a significant excess of STS was found in the population living within a 2-kilometre radius of an industrial incinerator located inside a Mantua industrial site. In the years 1974-1991, the incinerator burned hazardous chlorine-containing waste that resulted in the emission of dioxins. After 1991, it was exclusively fed with organic synthetic products not containing chlorine. OBJECTIVES the aim of this case-control study was to estimate the STS risk, for 1999-2014, in the population living in four Mantua districts located in the proximity of the industrial incinerator, compared to subjects resident in the remaining parts of Mantua province, regarded as non-exposed. METHODS the cases analysed were subjects with a first-incident diagnosis of STS between 1999 and 2014 resident at diagnosis in Mantua Province. Cases were selected using the 2013 criteria from the WHO classification. Cases of Kaposi sarcoma, PEComas and STS occurring in a previously irradiated field were excluded. For each case of soft-tissue sarcoma, four controls were randomly selected from all individuals resident in Mantua Province included in the Regional Health Service database in the years of incidence of each case (calendar year), and individually matched for gender and year of birth. Residential and occupational history (for employment in an oil refinery, and petrochemical and chemical plants) was reconstructed for all study subjects (cases and controls) since 1961. Subjects were considered exposed if they had lived in the four Mantua districts most affected by the incinerator emissions, on the basis of an atmospheric dispersion model and a dioxins biomonitoring survey. Four analyses were performed according to variously defined residential time windows. Odds ratios and corresponding 95% confidence intervals (95%CI) were calculated using conditional regression models adjusted for occupational history. RESULTS 391 cases (203 males and 188 females) and 1,564 controls were included. The number of exposed cases and controls in the four analyses were 8 and 55, 8 and 60, 15 and 68, and 15 and 73, respectively. An increased STS risk was not observed in any of the analyses. CONCLUSIONS in this study, no increased risk of STS was observed in subjects who had lived, in the study's time window, in the Mantua districts most affected by the incinerator emissions. The most likely interpretation of the present finding is a real STS risk reduction for subjects resident in the most recent decades in the Mantua districts most affected by the incinerator emissions, due to the cessation of burning chlorine-containing waste in the incinerator, development of some remediation plans, and implementation of new industrial procedures.
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Affiliation(s)
- Marta Benedetti
- Department of Environment and Health, Unit of Environmental and Social Epidemiology, Istituto Superiore di Sanità, Roma (Italy);
| | - Lucia Fazzo
- Department of Environment and Health, Unit of Environmental and Social Epidemiology, Istituto Superiore di Sanità, Roma (Italy)
| | - Linda Guarda
- Mantova Cancer Registry, Epidemilogy Unit, Agenzia di Tutela della Salute (ATS) della Val Padana, Mantova (Italy)
| | - Luciana Gatti
- Mantova Cancer Registry, Epidemilogy Unit, Agenzia di Tutela della Salute (ATS) della Val Padana, Mantova (Italy)
| | - Pietro Comba
- Department of Environment and Health, Unit of Environmental and Social Epidemiology, Istituto Superiore di Sanità, Roma (Italy)
| | - Paolo Ricci
- Mantova Cancer Registry, Epidemilogy Unit, Agenzia di Tutela della Salute (ATS) della Val Padana, Mantova (Italy)
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Zona A, Iavarone I, Buzzoni C, Conti S, Santoro M, Fazzo L, Pasetto R, Pirastu R, Bruno C, Ancona C, Bianchi F, Forastiere F, Manno V, Minelli G, Minerba A, Minichilli F, Stoppa G, Pierini A, Ricci P, Scondotto S, Bisceglia L, Cernigliaro A, Ranzi A, Comba P. [SENTIERI: Epidemiological Study of Residents in National Priority Contaminated Sites. Fifth Report]. Epidemiol Prev 2020; 43:1-208. [PMID: 31295974 DOI: 10.19191/ep19.2-3.s1.032] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION AND OBJECTIVES This volume provides an update of the health status of the populations living in the National Priority Contaminated Sites (NPCSs) included in the SENTIERI Project. This update is part of an epidemiological surveillance programme carried out in NPCSs, promoted by the Italian Ministry of Health as a further step of a project started in 2006, when the health status of residents in contaminated sites was first addressed within the National Strategic Program "Environment and Health". The Report focuses on five health outcomes: mortality, cancer incidence, hospital discharges, congenital anomalies, and children, adolescents and young adults' health. A key element of SENTIERI project is the a priori evaluation of the epidemiological evidence of a causal association between the considered cause of disease and the exposure. When an a priori evidence is identified, it is given a greater importance in the comment of the study findings. METHODS The present update of the SENTIERI Project concerns 45 NPCSs including in all 319 Italian Municipalities (out of over 8,000 Municipalities), with an overall population of 5,900,000 inhabitants at the 2011 Italian Census. Standardized Mortality Ratios (SMRs) and Standardized Hospitalization Ratios (SHRs), referring to a time window of 2006-2013, were computed for all the 45 NPCSs, using as a reference the corresponding mortality and hospitalization rates of the Regions where each NCPS is located. Standardized Incidence Ratios (SIRs) were computed by the Italian Association of Cancer Registries (AIRTUM) for the 22 NPCSs served by a Cancer Registry. AIRTUM covers about 56% of Italy, with partly different time-windows. SIRs have been estimated using as reference population the 4 macroareas in which Italy is divided (North-West, North-East, Centre, South). Prevalence of congenital anomalies was computed for 15 NPCSs. RESULTS An all-cause excess of 5,267 and 6,725 deaths was observed, respectively, in men and women; the cancer death excess was of 3,375 in men and 1,910 in women. It was estimated an excess of cancer incidence of 1,220 case in men and 1,425 in women over a five-year time window. With regard to the diseases with an a priori environmental aetiological validity, an excess for malignant mesothelioma, lung, colon, and gastric cancer, and for non-malignant respiratory diseases was observed. Cancer excess mainly affected NPCSs with presence of chemical and petrochemical plants, oil refineries, and dumping hazardous wastes. An excess of non-malignant respiratory disease was also detected in NPCSs in which steel industries and thermoelectric plants were present. An excess of mesothelioma was observed in NPCSs characterized by presence of asbestos and fluoro-edenite; it was also observed where the presence of asbestos was not reported in the legislative national decrees which define the NPCS areas. It is worth noting that, even if the presence of asbestos is not reported in many NPCSs legislative decrees, petrochemical plants and steel industries, for instance, are often characterized by the presence of a large amount of this mineral that, in the past, was extensively used as an insulating material. For the first time, the present Report includes a focus on the health status of children and adolescents (1,160,000 subjects, aged 0-19 years), and young adults (660,000 subjects, aged 20-29 years). Among infants (0-1 year), an excess of 7,000 hospitalizations was observed, 2,000 of which due to conditions of perinatal origin. In the age class 0-14, an excess of 22,000 hospitalizations for all causes was observed; 4,000 of them were due to acute respiratory diseases, and 2,000 to asthma. Data on cancer incidence for subjects aged 0-24 years were derived from general population cancer registries for twenty NPCSs, and from children cancer registries (age group: 0-19 years) for six NPCSs; 666 cases where diagnosed in the age group 0-24 years, corresponding to an excess of 9%. The main contributions to this excess are from soft tissue sarcomas in children (aged 0-14 years), acute myeloid leukaemia in children (aged 0-14 years) and in the age group 0-29 years, non-Hodgkin lymphoma and testicular cancer in young adults (aged 20-29 years). In seven out of 15 NPCSs, an excess prevalence rate of overall congenital anomalies at birth was observed. Congenital anomalies excesses included the following sites: genital organs, heart, limbs, nervous system, digestive system, and urinary system. CONCLUSIONS The main findings of SENTIERI Project have been the detection of excesses for the diseases which showed an a priori epidemiological evidence of a causal association with the environmental exposures specific for each considered NPCS. These observations are valuable within public health, because they contribute to priority health promotion activities. Looking ahead, the health benefits of an improved environmental quality might be appreciated in terms of reduction of the occurrence of adverse health effects attributable to each Site major pollutant agents. Due to the methodological approach of the present study, it was not possible to adjust for several confounding factors reported to be risk factors for the studied diseases (e.g., smoking, alcohol consumption, obesity). Even if excesses of mortality, hospitalization, cancer incidence, and prevalence of congenital anomalies were found in several NPCSs, the study design and the multifactorial aetiology of the considered diseases do not permit, for all of them, to draw conclusions in terms of causal links with environmental contamination. Moreover, it must be taken into consideration that economic factors and the availability of health services may also play a relevant role in a diseases outcome. A few observations regarding some methodological limitations of SENTIERI Project should be made. There is not a uniform environmental characterisation of the studied NPCSs in term of quality and detection of the pollutants, because this information is present in different databases which at present are not adequately connected. Moreover, the recognition of a contaminated site as a National Priority Site is based on soil and groundwater pollution, and the available information on air quality is currently sparse and not homogenous. Another limitation, in term of statistical power, is the small population size of many NPCSs and the low frequency of several health outcomes. A special caution must be paid in data interpretation when considering the correspondence between the contaminated areas and the municipality boundaries, as they do not always coincide perfectly: in some cases, a small municipality with a large industrial site, while in other settings only a part of the municipality is exposed to the sources of pollution. Furthermore, all available health information systems are currently accessible at municipality level. The real breakthrough is essentially comprised of the development and fostering of a networking system involving all local health authorities and regional environmental protection agencies operating in the areas under study. The possibility to integrate the geographic approach of SENTIERI Project with a set of ad hoc analytic epidemiological investigations, such as residential cohort studies, case control studies, children health surveys, biomonitoring surveys, and with socioepidemiological studies, might greatly contribute to the identification of health priorities for environmental remediation activities. Finally, as discussed in the last section of the report, there is a need to adopt, in each NPCS, a two-way oriented communication plan involving public health authorities, scientific community, and resident population, taking into account that the history, the cultural frame and the network of relationships specific of each local context play a major role in the risk perception perspective.
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Affiliation(s)
- Amerigo Zona
- Dipartimento Ambiente e Salute, Istituto Superiore di Sanità, Roma;
| | - Ivano Iavarone
- Dipartimento Ambiente e Salute, Istituto Superiore di Sanità, Roma
| | - Carlotta Buzzoni
- Registro Tumori Toscano, Istituto per lo Studio, la Prevenzione e la Rete Oncologica (ISPRO), Firenze
| | - Susanna Conti
- Servizio Tecnico Scientifico di Statistica, Istituto Superiore di Sanità, Roma
| | - Michele Santoro
- Unità di Epidemiologia Ambientale e Registri di Patologia, Istituto di Fisiologia Clinica, Consiglio Nazionale delle Ricerche, Pisa
| | - Lucia Fazzo
- Dipartimento Ambiente e Salute, Istituto Superiore di Sanità, Roma
| | - Roberto Pasetto
- Dipartimento Ambiente e Salute, Istituto Superiore di Sanità, Roma
| | - Roberta Pirastu
- Dipartimento di Biologia e Biotecnologie Charles Darwin, Sapienza Università di Roma
| | - Caterina Bruno
- Dipartimento Ambiente e Salute, Istituto Superiore di Sanità, Roma
| | - Carla Ancona
- Dipartimento di Epidemiologia del Servizio Sanitario Regionale, Regione Lazio, Roma
| | - Fabrizio Bianchi
- Istituto di Fisiologia Clinica, Consiglio Nazionale delle Ricerche, Pisa
| | - Francesco Forastiere
- Dipartimento di Epidemiologia del Servizio Sanitario Regionale, Regione Lazio, Roma
| | - Valerio Manno
- Servizio Tecnico Scientifico di Statistica, Istituto Superiore di Sanità, Roma
| | - Giada Minelli
- Servizio Tecnico Scientifico di Statistica, Istituto Superiore di Sanità, Roma
| | - Aldo Minerba
- Struttura Complessa Statistica ed Epidemiologia, ASL Taranto
| | - Fabrizio Minichilli
- Unità di Epidemiologia Ambientale e Registri di Patologia, Istituto di Fisiologia Clinica, Consiglio Nazionale delle Ricerche, Pisa
| | - Giorgia Stoppa
- Registro Tumori Toscano, Istituto per lo Studio, la Prevenzione e la Rete Oncologica (ISPRO), Firenze
| | - Anna Pierini
- Unità di Epidemiologia Ambientale e Registri di Patologia, Istituto di Fisiologia Clinica, Consiglio Nazionale delle Ricerche, Pisa
| | - Paolo Ricci
- UOC Osservatorio Epidemiologico, ATS Val Padana, Mantova
| | - Salvatore Scondotto
- Dipartimento Attività sanitarie e Osservatorio epidemiologico, Assessorato Salute Regione Siciliana, Palermo
| | - Lucia Bisceglia
- Agenzia Regionale Strategica per la Salute e il Sociale, Regione Puglia, Bari
| | - Achille Cernigliaro
- Dipartimento Attività sanitarie e Osservatorio epidemiologico, Assessorato Salute Regione Siciliana, Palermo
| | - Andrea Ranzi
- Direzione Tecnica, Centro Tematico Regionale Ambiente Salute, ARPAE Emilia-Romagna, Modena
| | - Pietro Comba
- Dipartimento Ambiente e Salute, Istituto Superiore di Sanità, Roma
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Magoni M, Donato F, Apostoli P, Rossi G, Comba P, Fazzo L, Speziani F, Leonardi L, Orizio G, Scarcella C, Anastasia A, Tucci A. Serum levels of polychlorinated biphenyls and risk of non-Hodgkin lymphoma: A hospital-based case-control study. Chemosphere 2019; 235:969-975. [PMID: 31561313 DOI: 10.1016/j.chemosphere.2019.06.193] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 06/06/2019] [Accepted: 06/25/2019] [Indexed: 06/10/2023]
Abstract
Polychlorinated biphenyls (PCB) have been classified by the International Agency for Research on Cancer (IARC) in Group 1 as carcinogenic to human, based on sufficient evidence in humans of an increased risk of cutaneous malignant melanoma and limited evidence for non-Hodgkin lymphoma (NHL). However present findings on the association of PCB exposure and NHL are still controversial. This study examined the relationship between PCB serum levels and risk of NHL in a Northern Italy area (Brescia province), where a chemical factory produced PCBs from 1938 to 1984, causing human contamination. A case-control study of 215 NHL patients and 215 control subjects was conducted. Cases and controls were assayed for serum levels of 33 PCB congeners. No associations were found between risk of NHL and serum levels of total PCBs (OR = 0.51; 95% CI: 0.25-1.04 for highest vs lowest quartile) or specific PCB congeners. The study confirmed a strong association of NHL with HCV infection (OR = 3.60; 95% CI: 1.30-10.02). This case-control study does not support the hypothesis of an association between current serum levels of PCBs and NHL development in the general population.
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Affiliation(s)
- Michele Magoni
- ATS Brescia (Brescia Health Protection Agency), Brescia, Italy.
| | - Francesco Donato
- Department of Medical and Surgical Specialties Radiological Sciences and Public Health, Unit of Hygiene, Epidemiology, and Public Health, University of Brescia, Italy
| | - Pietro Apostoli
- Department of Medical and Surgical Specialties Radiological Sciences and Public Health, Institute of Occupational Health and Industrial Hygiene, University of Brescia, Italy
| | - Giuseppe Rossi
- Division of Haematology, Department of Clinical Oncology, ASST Spedali Civili, Brescia, Italy
| | - Pietro Comba
- Department of Environment and Health, Istituto Superiore di Sanità, Rome, Italy
| | - Lucia Fazzo
- Department of Environment and Health, Istituto Superiore di Sanità, Rome, Italy
| | | | - Lucia Leonardi
- ATS Brescia (Brescia Health Protection Agency), Brescia, Italy
| | - Grazia Orizio
- ATS Brescia (Brescia Health Protection Agency), Brescia, Italy
| | | | - Antonella Anastasia
- Division of Haematology, Department of Clinical Oncology, ASST Spedali Civili, Brescia, Italy
| | - Alessandra Tucci
- Division of Haematology, Department of Clinical Oncology, ASST Spedali Civili, Brescia, Italy
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20
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Hoek G, Ranzi A, Alimehmeti I, Ardeleanu ER, Arrebola JP, Ávila P, Candeias C, Colles A, Crișan GC, Dack S, Demeter Z, Fazzo L, Fierens T, Flückiger B, Gaengler S, Hänninen O, Harzia H, Hough R, Iantovics BL, Kalantzi OI, Karakitsios SP, Markis KC, Martin-Olmedo P, Nechita E, Nicoli T, Orru H, Pasetto R, Pérez-Carrascosa FM, Pestana D, Rocha F, Sarigiannis DA, Teixeira JP, Tsadilas C, Tasic V, Vaccari L, Iavarone I, de Hoogh K. A review of exposure assessment methods for epidemiological studies of health effects related to industrially contaminated sites. Epidemiol Prev 2019; 42:21-36. [PMID: 30322233 DOI: 10.19191/ep18.5-6.s1.p021.085] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND this paper is based upon work from COST Action ICSHNet. Health risks related to living close to industrially contaminated sites (ICSs) are a public concern. Toxicology-based risk assessment of single contaminants is the main approach to assess health risks, but epidemiological studies which investigate the relationships between exposure and health directly in the affected population have contributed important evidence. Limitations in exposure assessment have substantially contributed to uncertainty about associations found in epidemiological studies. OBJECTIVES to examine exposure assessment methods that have been used in epidemiological studies on ICSs and to provide recommendations for improved exposure assessment in epidemiological studies by comparing exposure assessment methods in epidemiological studies and risk assessments. METHODS after defining the multi-media framework of exposure related to ICSs, we discussed selected multi-media models applied in Europe. We provided an overview of exposure assessment in 54 epidemiological studies from a systematic review of hazardous waste sites; a systematic review of 41 epidemiological studies on incinerators and 52 additional studies on ICSs and health identified for this review. RESULTS we identified 10 multi-media models used in Europe primarily for risk assessment. Recent models incorporated estimation of internal biomarker levels. Predictions of the models differ particularly for the routes 'indoor air inhalation' and 'vegetable consumption'. Virtually all of the 54 hazardous waste studies used proximity indicators of exposure, based on municipality or zip code of residence (28 studies) or distance to a contaminated site (25 studies). One study used human biomonitoring. In virtually all epidemiological studies, actual land use was ignored. In the 52 additional studies on contaminated sites, proximity indicators were applied in 39 studies, air pollution dispersion modelling in 6 studies, and human biomonitoring in 9 studies. Exposure assessment in epidemiological studies on incinerators included indicators (presence of source in municipality and distance to the incinerator) and air dispersion modelling. Environmental multi-media modelling methods were not applied in any of the three groups of studies. CONCLUSIONS recommendations for refined exposure assessment in epidemiological studies included the use of more sophisticated exposure metrics instead of simple proximity indicators where feasible, as distance from a source results in misclassification of exposure as it ignores key determinants of environmental fate and transport, source characteristics, land use, and human consumption behaviour. More validation studies using personal exposure or human biomonitoring are needed to assess misclassification of exposure. Exposure assessment should take more advantage of the detailed multi-media exposure assessment procedures developed for risk assessment. The use of indicators can be substantially improved by linking definition of zones of exposure to existing knowledge of extent of dispersion. Studies should incorporate more often land use and individual behaviour.
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Affiliation(s)
- Gerard Hoek
- Institute for Risk Assessment Sciences, Utrecht University (The Netherlands).
| | - Andrea Ranzi
- Environmental Health Reference Centre, Regional Agency for Prevention, Environment and Energy of Emilia-Romagna, Modena (Italy)
| | - Ilir Alimehmeti
- Occupational Health Department, Faculty of Medicine, University of Medicine, Tirana (Albania)
| | | | - Juan P Arrebola
- Instituto de Investigación Biosanitaria de Granada (ibs. GRANADA), University of Granada (Spain).,CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid (Spain).,Oncology Unit, Virgen de las Nieves University Hospital, Granada (Spain)
| | - Paula Ávila
- National Laboratory of Energy and Geology (LNEG), Amadora (Portugal)
| | - Carla Candeias
- EpiUnit, Public Health Institute, University of Porto (Portugal).,GeoBioTec, Geosciences Department, University of Aveiro, Santiago Campus (Portugal)
| | - Ann Colles
- Sustainable Health, Flemish Institute for Technological Research (VITO), Boeretang (Belgium)
| | | | - Sarah Dack
- Environmental Hazards and Emergencies Department, Centre for Radiation, Chemical and Environmental Hazards, Public Health England, London (UK)
| | | | - Lucia Fazzo
- Unit of Environmental and Social Epidemiology, Department of Environment and Health, Italian National Health Institute (ISS), Rome (Italy)
| | - Tine Fierens
- Sustainable Health, Flemish Institute for Technological Research (VITO), Boeretang (Belgium)
| | - Benjamin Flückiger
- Swiss Tropical and Public Health Institute, Basel (Switzerland).,University of Basel, Basel (Switzerland)
| | - Stephanie Gaengler
- Water and Health Laboratory, Cyprus International Institute for Environmental and Public Health, Cyprus University of Technology, Limssol (Cyprus)
| | - Otto Hänninen
- Department Public Health Solutions, National Institute for Health and Welfare, Helsinki (Finland)
| | - Hedi Harzia
- Department of Environmental Health, Estonian Health Board, Tallinn (Estonia)
| | - Rupert Hough
- James Hutton Institute, Craigiebuckler, Aberdeen, Scotland (UK)
| | | | | | - Spyros P Karakitsios
- Department of Chemical Engineering, Environmental Engineering Laboratory, Aristotle University of Thessaloniki (Greece).,HERACLES Research Center on the Exposome and Health, Center for Interdisciplinary Research and Innovation, Balkan Center, Thessaloniki (Greece)
| | - Konstantinos C Markis
- Water and Health Laboratory, Cyprus International Institute for Environmental and Public Health, Cyprus University of Technology, Limssol (Cyprus)
| | | | | | - Thomai Nicoli
- Hellenic Agricultural Organization, General Directorship of Agricultural Research, Institute of Industrial and Forage Crops, Larissa (Greece)
| | - Hans Orru
- Institute of Family Medicine and Public Health, University of Tartu (Estonia)
| | - Roberto Pasetto
- Unit of Environmental and Social Epidemiology, Department of Environment and Health, Italian National Health Institute (ISS), Rome (Italy)
| | - Francisco Miguel Pérez-Carrascosa
- Instituto de Investigación Biosanitaria de Granada (ibs. GRANADA), University of Granada (Spain).,Oncology Unit, Virgen de las Nieves University Hospital, Granada (Spain)
| | - Diogo Pestana
- ICenter for Health Technology and Services Research (CINTESIS), Porto (Portugal).,Nutrition&Metabolism, NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa (Portugal)
| | - Fernando Rocha
- GeoBioTec, Geosciences Department, University of Aveiro, Santiago Campus (Portugal)
| | - Dimosthenis A Sarigiannis
- Department of Chemical Engineering, Environmental Engineering Laboratory, Aristotle University of Thessaloniki (Greece).,HERACLES Research Center on the Exposome and Health, Center for Interdisciplinary Research and Innovation, Balkan Center, Thessaloniki (Greece).,University School for Advanced Study (IUSS), Pavia (Italy)
| | | | - Christos Tsadilas
- Hellenic Agricultural Organization, General Directorship of Agricultural Research, Institute of Industrial and Forage Crops, Larissa (Greece)
| | - Visa Tasic
- Department for Industrial Informatics, Mining and Metallurgy Institute Bor (Serbia)
| | - Lorenzo Vaccari
- Environmental Health Reference Centre, Regional Agency for Prevention, Environment and Energy of Emilia-Romagna, Modena (Italy).,Department of Engineering "Enzo Ferrari", University of Modena and Reggio Emilia (Italy)
| | - Ivano Iavarone
- Unit of Environmental and Social Epidemiology, Department of Environment and Health, Italian National Health Institute (ISS), Rome (Italy)
| | - Kees de Hoogh
- Swiss Tropical and Public Health Institute, Basel (Switzerland).,University of Basel, Basel (Switzerland)
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21
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Zona A, Fazzo L, Minelli G, De Santis M, Bruno C, Conti S, Comba P. Peritoneal mesothelioma mortality in Italy: Spatial analysis and search for asbestos exposure sources. Cancer Epidemiol 2019; 60:162-167. [PMID: 31030080 DOI: 10.1016/j.canep.2019.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 03/08/2019] [Accepted: 04/02/2019] [Indexed: 01/20/2023]
Abstract
BACKGROUND This study is part of a national plan of epidemiological surveillance of malignant mesothelioma (MM) mortality in Italy. The paper shows the results of malignant peritoneal mesothelioma (MPeM) mortality study in Italian Regions and municipalities. METHODS National Bureau of Statistics data for MPeM municipal mortality (ICD-10, Code C45.1) were analyzed in the time-window 2003-2014: mortality standardized rates (reference Italian population, census 2011), temporal trends of the annual national rates, Standardized Mortality Ratios and a municipal clustering analysis were performed. RESULTS 747 deaths for MPeM were recorded (0.10/100,000): 464 in men (0.14/100,000) and in 283 women (0.07/100,000). No significant MPeM mortality temporal trend was found. Seventeen municipalities showed excesses of mortality for MPeM in at least one gender and/or overall population. Four clusters in male population, and one in women were identified. CONCLUSIONS The study identifies some areas where remediation activities and/or health care actions may be warranted.
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Affiliation(s)
- A Zona
- Department of Environment and Health, Istituto Superiore di Sanità, viale Regina Elena, 299 I-00161 Rome, Italy.
| | - L Fazzo
- Department of Environment and Health, Istituto Superiore di Sanità, viale Regina Elena, 299 I-00161 Rome, Italy.
| | - G Minelli
- Statistical Service, Istituto Superiore di Sanità, viale Regina Elena, 299 I-00161 Rome, Italy.
| | - M De Santis
- Department of Environment and Health, Istituto Superiore di Sanità, viale Regina Elena, 299 I-00161 Rome, Italy.
| | - C Bruno
- Department of Environment and Health, Istituto Superiore di Sanità, viale Regina Elena, 299 I-00161 Rome, Italy.
| | - S Conti
- Statistical Service, Istituto Superiore di Sanità, viale Regina Elena, 299 I-00161 Rome, Italy.
| | - P Comba
- Department of Environment and Health, Istituto Superiore di Sanità, viale Regina Elena, 299 I-00161 Rome, Italy.
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22
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Pasetto R, Zona A, Fazzo L, Binazzi A, Bruno C, Pirastu R, Comba P, Marinaccio A. Proportion of mesothelioma attributable to living in industrially contaminated areas in
Italy. Scand J Work Environ Health 2019; 45:444-449. [DOI: 10.5271/sjweh.3809] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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23
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Marsili D, Magnani C, Canepa A, Bruno C, Luberto F, Caputo A, Fazzo L, Zona A, Comba P. Communication and health education in communities experiencing asbestos risk and health impacts in Italy. Ann Ist Super Sanita 2019; 55:70-79. [PMID: 30968841 DOI: 10.4415/ann_19_01_14] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Numerous municipalities in Italy currently experience asbestos health impact, in particular excesses of pleural mesothelioma incidence and mortality. This paper presents an integrated analysis of epidemiological studies and communication actions in affected municipalities to highlight how communication has been implemented depending on health impact evidence and involvement of local stakeholders. METHODOLOGY Four case studies are identified concerning industrial and natural sources of asbestos exposure having different diseases burden. This integrated analysis benefited from multidisciplinary skills. DISCUSSION Evidence of different stakeholders engagement is presented to emphasize their role in the communication process. Similarities and differences among case studies allowed us to identify lessons-learned to be transferred in other asbestos contaminated sites. CONCLUSIONS The adoption of communication strategies and practices, since the very early evidence of asbestos health impact, represents a relevant contribution for epidemiological and health surveillance, particularly for those communities where asbestos health impact has only been recently reported.
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Affiliation(s)
- Daniela Marsili
- Dipartimento Ambiente e Salute, Istituto Superiore di Sanità, Rome, Italy - WHO Collaborating Centre for Environmental Health in Contaminated Sites, Istituto Superiore di Sanità,Rome, Italy
| | - Corrado Magnani
- Dipartimento di Medicina Traslazionale, Università del Piemonte Orientale e CPO Piemonte, Novara, Italy
| | - Adriana Canepa
- Istituto di Istruzione Superiore "Cesare Balbo" della rete ScuoleInsieme, Casale Monferrato, Alessandria, Italy
| | - Caterina Bruno
- Dipartimento Ambiente e Salute, Istituto Superiore di Sanità, Rome, Italy - WHO Collaborating Centre for Environmental Health in Contaminated Sites, Istituto Superiore di Sanità,Rome, Italy
| | - Ferdinando Luberto
- Servizio di Epidemiologia e Comunicazione, AUSL e IRCCS Reggio Emilia, Reggio Emilia, Italy
| | | | - Lucia Fazzo
- Dipartimento Ambiente e Salute, Istituto Superiore di Sanità, Rome, Italy - WHO Collaborating Centre for Environmental Health in Contaminated Sites, Istituto Superiore di Sanità,Rome, Italy
| | - Amerigo Zona
- Dipartimento Ambiente e Salute, Istituto Superiore di Sanità, Rome, Italy - WHO Collaborating Centre for Environmental Health in Contaminated Sites, Istituto Superiore di Sanità,Rome, Italy
| | - Pietro Comba
- Dipartimento Ambiente e Salute, Istituto Superiore di Sanità, Rome, Italy - WHO Collaborating Centre for Environmental Health in Contaminated Sites, Istituto Superiore di Sanità,Rome, Italy
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24
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Comba P, D'Angelo M, Fazzo L, Magnani C, Marinaccio A, Mirabelli D, Terracini B. Mesothelioma in Italy: the Casale Monferrato model to a national epidemiological surveillance system. Ann Ist Super Sanita 2018; 54:139-148. [PMID: 29916419 DOI: 10.4415/ann_18_02_10] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The purpose of the present paper is to review the origin and development of the epidemiology of mesothelioma in Italy, starting with the detection and investigation of the major outbreak of the disease observed in Casale Monferrato, Piedmont Region. Over the last four decades, mortality among the cohort of ex-Eternit workers has been measured at three points in time. More recently, population based case-control studies in the area of Casale Monferrato have provided new light on the dose-response curve of the relationship between asbestos exposure and mesotheliomas. The publication of the first Casale Monferrato study had a major impact in the country and contributed to the decision of the Italian Parliament to ban the use of asbestos. The experience of Casale Monferrato represents a lesson in several terms, from the epidemiological surveillance to the health care of the victims and the relationship between epidemiologists, victims, their relatives and residents in contaminated areas.
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Affiliation(s)
- Pietro Comba
- Dipartimento Ambiente e Salute, Istituto Superiore di Sanità, Rome, Italy
| | - Massimo D'Angelo
- Centro Sanitario Amianto Piemonte, Casale Monferrato (Alessandria), Italy
| | - Lucia Fazzo
- Dipartimento Ambiente e Salute, Istituto Superiore di Sanità, Rome, Italy
| | - Corrado Magnani
- Dipartimento di Medicina Translazionale, Università del Piemonte Orientale, Novara, Italy
| | - Alessandro Marinaccio
- Dipartimento di Epidemiologia e Igiene, Istituto Nazionale Assicurazione Infortuni sul Lavoro, Rome, Italy
| | - Dario Mirabelli
- Epidemiologia dei Tumori, CPO-Piemonte e Università di Torino, Turin, Italy
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25
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Fazzo L, Minelli G, De Santis M, Bruno C, Zona A, Conti S, Comba P. Epidemiological surveillance of mesothelioma mortality in Italy. Cancer Epidemiol 2018; 55:184-191. [PMID: 29990795 DOI: 10.1016/j.canep.2018.06.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 05/31/2018] [Accepted: 06/26/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND Malignant mesothelioma (MM) is causally linked to asbestos exposure with an estimated etiological fraction of 80% or more. METHODS Standardized rates of all mesothelioma (C45, ICD-10) and malignant pleural mesothelioma (C45.0, ICD-10) mortality in Italy were computed at national and regional levels, for the period 2003-2014. Standardized Mortality Ratios (SMRs, with 95% Confidence Intervals) were calculated for each of the 8047 Italian municipalities, for both diseases, with respect to Regional figures. A geographical clustering analysis at municipal level was performed, applying SatScan methods. RESULTS In Italy, 16,086 persons (about 1,340/year) died for MM, in analysed period. National Standardized rates of MM mortality are 3.65/100,000 in men and 1.09/100,000 in women, with an increasing annual trend, among male population. The highest rates were found in men from Northern Regions. Significant clusters (p < 0.10) were found corresponding to areas that hosted major asbestos-cement plants, naval shipyards, petrochemical plants and refineries. Furthermore, excesses were found corresponding to chemical and textile industries; the latter involving, particularly, female population. Excesses were found also in areas near the chrysotile mine of Balangero, and in Biancavilla, a town with a stone quarry contaminated by fluoro-edenitic fibres; an excess of MM mortality was observed among male population living in a minor island where a Navy shipyard is located. CONCLUSIONS Mortality for mesothelioma in Italy is still increasing, twenty-six years after the asbestos ban. Epidemiological surveillance of mesothelioma mortality allows to detect the temporal trend of the disease and highlights previously unknown or underestimated sources of asbestos exposure.
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Affiliation(s)
- Lucia Fazzo
- Dept of Environment and Health, Istituto Superiore di Sanità, viale Regina Elena, 299 - 00161 Roma, Italy.
| | - Giada Minelli
- Statistical Service, Istituto Superiore di Sanità, viale Regina Elena, 299 - 00161 Roma, Italy.
| | - Marco De Santis
- Dept of Environment and Health, Istituto Superiore di Sanità, viale Regina Elena, 299 - 00161 Roma, Italy.
| | - Caterina Bruno
- Dept of Environment and Health, Istituto Superiore di Sanità, viale Regina Elena, 299 - 00161 Roma, Italy.
| | - Amerigo Zona
- Dept of Environment and Health, Istituto Superiore di Sanità, viale Regina Elena, 299 - 00161 Roma, Italy.
| | - Susanna Conti
- Statistical Service, Istituto Superiore di Sanità, viale Regina Elena, 299 - 00161 Roma, Italy.
| | - Pietro Comba
- Dept of Environment and Health, Istituto Superiore di Sanità, viale Regina Elena, 299 - 00161 Roma, Italy.
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Vermeulen R, Saberi Hosnijeh F, Bodinier B, Portengen L, Liquet B, Garrido-Manriquez J, Lokhorst H, Bergdahl IA, Kyrtopoulos SA, Johansson AS, Georgiadis P, Melin B, Palli D, Krogh V, Panico S, Sacerdote C, Tumino R, Vineis P, Castagné R, Chadeau-Hyam M, Botsivali M, Chatziioannou A, Valavanis I, Kleinjans JCS, de Kok TMCM, Keun HC, Athersuch TJ, Kelly R, Lenner P, Hallmans G, Stephanou EG, Myridakis A, Kogevinas M, Fazzo L, De Santis M, Comba P, Bendinelli B, Kiviranta H, Rantakokko P, Airaksinen R, Ruokojarvi P, Gilthorpe M, Fleming S, Fleming T, Tu YK, Lundh T, Chien KL, Chen WJ, Lee WC, Kate Hsiao C, Kuo PH, Hung H, Liao SF. Pre-diagnostic blood immune markers, incidence and progression of B-cell lymphoma and multiple myeloma: Univariate and functionally informed multivariate analyses. Int J Cancer 2018; 143:1335-1347. [PMID: 29667176 PMCID: PMC6100111 DOI: 10.1002/ijc.31536] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Revised: 03/15/2018] [Accepted: 03/19/2018] [Indexed: 12/13/2022]
Abstract
Recent prospective studies have shown that dysregulation of the immune system may precede the development of B‐cell lymphomas (BCL) in immunocompetent individuals. However, to date, the studies were restricted to a few immune markers, which were considered separately. Using a nested case–control study within two European prospective cohorts, we measured plasma levels of 28 immune markers in samples collected a median of 6 years before diagnosis (range 2.01–15.97) in 268 incident cases of BCL (including multiple myeloma [MM]) and matched controls. Linear mixed models and partial least square analyses were used to analyze the association between levels of immune marker and the incidence of BCL and its main histological subtypes and to investigate potential biomarkers predictive of the time to diagnosis. Linear mixed model analyses identified associations linking lower levels of fibroblast growth factor‐2 (FGF‐2 p = 7.2 × 10−4) and transforming growth factor alpha (TGF‐α, p = 6.5 × 10−5) and BCL incidence. Analyses stratified by histological subtypes identified inverse associations for MM subtype including FGF‐2 (p = 7.8 × 10−7), TGF‐α (p = 4.08 × 10−5), fractalkine (p = 1.12 × 10−3), monocyte chemotactic protein‐3 (p = 1.36 × 10−4), macrophage inflammatory protein 1‐alpha (p = 4.6 × 10−4) and vascular endothelial growth factor (p = 4.23 × 10−5). Our results also provided marginal support for already reported associations between chemokines and diffuse large BCL (DLBCL) and cytokines and chronic lymphocytic leukemia (CLL). Case‐only analyses showed that Granulocyte‐macrophage colony stimulating factor levels were consistently higher closer to diagnosis, which provides further evidence of its role in tumor progression. In conclusion, our study suggests a role of growth‐factors in the incidence of MM and of chemokine and cytokine regulation in DLBCL and CLL. What's new? B‐cell lymphomas (BCL) are frequent in immunocompromised individuals, but most BCL cases are thought to occur as a consequence of minor immune perturbations in otherwise immunocompetent individuals. Here the authors prospectively examined a panel of immune markers in the blood from 268 patients afflicted with BCL and paired controls. The data uncover a functional role for growth factors (i.e. FGF‐2, TGF‐alpha) in the incidence and progression of multiple myeloma, a BCL subtype, and underscore the importance of chemokine and cytokine regulation in diffuse large B‐cell lymphoma and chronic lymphocytic leukemia.
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Affiliation(s)
- Roel Vermeulen
- Division of Environmental Epidemiology, Utrecht University, Institute for Risk Assessment Sciences, Utrecht, The Netherlands.,MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, Imperial College London, London, United Kingdom
| | - Fatemeh Saberi Hosnijeh
- Division of Environmental Epidemiology, Utrecht University, Institute for Risk Assessment Sciences, Utrecht, The Netherlands.,Immunology Department, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Barbara Bodinier
- MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, Imperial College London, London, United Kingdom
| | - Lützen Portengen
- Division of Environmental Epidemiology, Utrecht University, Institute for Risk Assessment Sciences, Utrecht, The Netherlands
| | - Benoît Liquet
- Laboratoire de Mathématiques et de leurs Applications, Université de Pau et des Pays de l'Adour, UMR CNRS, Pau, France.,ARC Centre of Excellence for Mathematical and Statistical Frontiers, Queensland University of Technology (QUT), Brisbane, Australia
| | - Javiera Garrido-Manriquez
- MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, Imperial College London, London, United Kingdom
| | - Henk Lokhorst
- Department of Hematology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Ingvar A Bergdahl
- Department of Public Health and Clinical Medicine, and Department of Biobank Research, Umeå University, Umeå, Sweden
| | - Soterios A Kyrtopoulos
- National Hellenic Research Foundation, Institute of Biology, Medicinal Chemistry and Biotechnology, Athens, Greece
| | | | - Panagiotis Georgiadis
- National Hellenic Research Foundation, Institute of Biology, Medicinal Chemistry and Biotechnology, Athens, Greece
| | - Beatrice Melin
- Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden
| | - Domenico Palli
- The Institute for Cancer Research and Prevention, Florence, Italy
| | - Vittorio Krogh
- Fondazione IRCCS-Instituto Nazionale dei Tumori, Milan, Italy
| | - Salvatore Panico
- Department of Clinical Medicine and Surgery, University of Naples Frederico II, Naples, Italy
| | - Carlotta Sacerdote
- Piedmont Reference Centre for Epidemiology and Cancer Prevention (CPO Piemonte), Turin, Italy
| | - Rosario Tumino
- Cancer registry and Histopathology Unit, Azienda Ospedaliera 'Civile-M.P.Arezzo', Ragusa, Italy
| | - Paolo Vineis
- MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, Imperial College London, London, United Kingdom.,HuGeF Foundation, Torino, Italy
| | - Raphaële Castagné
- MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, Imperial College London, London, United Kingdom.,INSERM, UMR1027, Université Toulouse III-Paul Sabatier, Toulouse, France
| | - Marc Chadeau-Hyam
- Division of Environmental Epidemiology, Utrecht University, Institute for Risk Assessment Sciences, Utrecht, The Netherlands.,MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, Imperial College London, London, United Kingdom
| | | | - Maria Botsivali
- Institute of Biology, Medicinal Chemistry and Biotechnology, National Hellenic Research Foundation, Athens, Greece
| | - Aristotelis Chatziioannou
- Institute of Biology, Medicinal Chemistry and Biotechnology, National Hellenic Research Foundation, Athens, Greece
| | - Ioannis Valavanis
- Institute of Biology, Medicinal Chemistry and Biotechnology, National Hellenic Research Foundation, Athens, Greece
| | - Jos C S Kleinjans
- Department of Toxicogenomics, Maastricht University, Maastricht, The Netherlands
| | - Theo M C M de Kok
- Department of Toxicogenomics, Maastricht University, Maastricht, The Netherlands
| | - Hector C Keun
- Division of Cancer, Department of Surgery and Cancer, Imperial College London, Institute of Reproductive and Developmental Biology (IRDB), Hammersmith Hospital, London, United Kingdom
| | - Toby J Athersuch
- MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, Imperial College London, London, United Kingdom.,Division of Computational and Systems Medicine, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Rachel Kelly
- Immunology Department, Erasmus University Medical Center, Rotterdam, The Netherlands.,Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, USA
| | - Per Lenner
- Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden
| | - Goran Hallmans
- Nutrition Research, Department of Public Health and Clinical Medicine, and Department of Biobank Research, Umeå University, Umeå, Sweden
| | | | - Antonis Myridakis
- Environmental Chemical Processes Laboratory, University of Crete, Heraklion, Greece
| | - Manolis Kogevinas
- ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain
| | | | | | | | | | | | | | | | | | | | | | | | - Yu-Kang Tu
- University of Leeds, Leeds, United Kingdom
| | | | | | - Wei J Chen
- National Taiwan University, Taipei, Taiwan
| | | | | | | | - Hung Hung
- National Taiwan University, Taipei, Taiwan
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Magoni M, Apostoli P, Donato F, Manganoni A, Comba P, Fazzo L, Speziani F, Leonardi L, Orizio G, Scarcella C, Calzavara Pinton P. Plasma levels of polychlorinated biphenyls and risk of cutaneous malignant melanoma: A hospital-based case-control study. Environ Int 2018; 113:20-25. [PMID: 29421403 DOI: 10.1016/j.envint.2018.01.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 01/15/2018] [Accepted: 01/20/2018] [Indexed: 05/20/2023]
Abstract
Polychlorinated biphenyls (PCB) have been classified by the International Agency for Research on Cancer (IARC) in Group 1 as carcinogenic to human, based on sufficient evidence in humans of an increased risk of cutaneous malignant melanoma (CMM), however few studies have been done in the general population. This study examined the relationship between PCB plasma levels and risk of CMM adjusting for sun sensitivity and sun exposure in a province of Northern Italy (Brescia), where a chemical factory produced PCBs from 1938 to 1984 causing human contamination. A case-control study of 205 CMM patients and 205 control subjects was conducted. Cases and controls were assayed for plasma levels of 33 PCB congeners. No associations was found between risk of CMM and plasma levels of total PCB (OR = 0.81; 95% CI: 0.34-1.96 for highest vs lowest quartile) or specific congeners. The study confirmed the association with light skin colour (OR = 3.00; 95% CI: 1.91-4.73), cumulative lifetime UV exposure (OR = 2.56; 95% CI: 1.35-4.85) and high level of education (OR = 1.45; 95% CI: 1.03-2.05). This case-control study does not support the hypothesis of an association between current plasma levels of PCBs and CMM development in the general population.
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Affiliation(s)
- Michele Magoni
- ATS Brescia (Brescia Health Protection Agency), Brescia, Italy.
| | - Pietro Apostoli
- Department of Medical and Surgical Specialties Radiological Sciences and Public Health, Institute of Occupational Health and Industrial Hygiene, University of Brescia, Italy
| | - Francesco Donato
- Department of Medical and Surgical Specialties Radiological Sciences and Public Health, Unit of Hygiene, Epidemiology, and Public Health, University of Brescia, Italy
| | - Ausilia Manganoni
- Section of Dermatology, Department of Clinical and Experimental Sciences, University of Brescia, Italy
| | - Pietro Comba
- Department of Environment and Health, Istituto Superiore di Sanità, Rome, Italy
| | - Lucia Fazzo
- Department of Environment and Health, Istituto Superiore di Sanità, Rome, Italy
| | | | - Lucia Leonardi
- ATS Brescia (Brescia Health Protection Agency), Brescia, Italy
| | - Grazia Orizio
- ATS Brescia (Brescia Health Protection Agency), Brescia, Italy
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Fazzo L, Minichilli F, Santoro M, Ceccarini A, Della Seta M, Bianchi F, Comba P, Martuzzi M. Hazardous waste and health impact: a systematic review of the scientific literature. Environ Health 2017; 16:107. [PMID: 29020961 PMCID: PMC5637250 DOI: 10.1186/s12940-017-0311-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 09/26/2017] [Indexed: 05/07/2023]
Abstract
Waste is part of the agenda of the European Environment and Health Process and included among the topics of the Sixth Ministerial Conference on Environment and Health. Disposal and management of hazardous waste are worldwide challenges. We performed a systematic review to evaluate the evidence of the health impact of hazardous waste exposure, applying transparent and a priori defined methods. The following five steps, based on pre-defined systematic criteria, were applied. 1. Specify the research question, in terms of "Population-Exposure-Comparators-Outcomes" (PECO). POPULATION people living near hazardous waste sites; Exposure: exposure to hazardous waste; Comparators: all comparators; Outcomes: all diseases/health disorders. 2. Carry out the literature search, in Medline and EMBASE. 3. Select studies for inclusion: original epidemiological studies, published between 1999 and 2015, on populations residentially exposed to hazardous waste. 4. Assess the quality of selected studies, taking into account study design, exposure and outcome assessment, confounding control. 5. Rate the confidence in the body of evidence for each outcome taking into account the reliability of each study, the strength of the association and concordance of results.Fifty-seven papers of epidemiological investigations on the health status of populations living near hazardous waste sites were selected for the evidence evaluation. The association between 95 health outcomes (diseases and disorders) and residential exposure to hazardous waste sites was evaluated. Health effects of residential hazardous waste exposure, previously partially unrecognized, were highlighted. Sufficient evidence was found of association between exposure to oil industry waste that releases high concentrations of hydrogen sulphide and acute symptoms. The evidence of causal relationship with hazardous waste was defined as limited for: liver, bladder, breast and testis cancers, non-Hodgkin lymphoma, asthma, congenital anomalies overall and anomalies of the neural tube, urogenital, connective and musculoskeletal systems, low birth weight and pre-term birth; evidence was defined as inadequate for the other health outcomes. The results, although not conclusive, provide indications that more effective public health policies on hazardous waste management are urgently needed. International, national and local authorities should oppose and eliminate poor, outdated and illegal practices of waste disposal, including illegal transboundary trade, and increase support regulation and its enforcement.
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Affiliation(s)
- L. Fazzo
- Department of Environment and Health, Unit of Environmental and Social Epidemiology, Istituto Superiore di Sanità, viale Regina Elena 299, 00161 Rome, Italy
| | - F. Minichilli
- Institute of Clinical Physiology, Unit of Environmental epidemiology and disease registries, National Research Council, Via Giuseppe Moruzzi 1, 56124 Pisa, Italy
| | - M. Santoro
- Institute of Clinical Physiology, Unit of Environmental epidemiology and disease registries, National Research Council, Via Giuseppe Moruzzi 1, 56124 Pisa, Italy
| | - A. Ceccarini
- Documentation Service, Istituto Superiore di Sanità, viale Regina Elena 299, 00161 Rome, Italy
| | - M. Della Seta
- Documentation Service, Istituto Superiore di Sanità, viale Regina Elena 299, 00161 Rome, Italy
| | - F. Bianchi
- Institute of Clinical Physiology, Unit of Environmental epidemiology and disease registries, National Research Council, Via Giuseppe Moruzzi 1, 56124 Pisa, Italy
| | - P. Comba
- Department of Environment and Health, Unit of Environmental and Social Epidemiology, Istituto Superiore di Sanità, viale Regina Elena 299, 00161 Rome, Italy
| | - M. Martuzzi
- Centre for Environment and Health, World Health Organization - Regional Office for Europe, Platz der Vereinten Nationen 1, D-53113 Bonn, Germany
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Binazzi A, Marinaccio A, Corfiati M, Bruno C, Fazzo L, Pasetto R, Pirastu R, Biggeri A, Catelan D, Comba P, Zona A. Mesothelioma incidence and asbestos exposure in Italian national priority contaminated sites. Scand J Work Environ Health 2017; 43:550-559. [PMID: 28985440 DOI: 10.5271/sjweh.3676] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Objectives This study aimed to (i) describe mesothelioma incidence in the Italian national priority contaminated sites (NPCS) on the basis of data available from the Italian National Mesothelioma Registry (ReNaM) and (ii) profile NPCS using Bayesian rank analysis. Methods Incident cases of mesothelioma and standardized incidence ratios (SIR) were estimated for both genders in each of the 39 selected NPCS in the period 2000-2011. Age-standardized rates of Italian geographical macro areas were used to estimate expected cases. Rankings of areas were produced by a hierarchical Bayesian model. Asbestos exposure modalities were discussed for each site. Results In the study period, 2683 incident cases of mesothelioma (1998 men, 685 women) were recorded. An excess of mesothelioma incidence was confirmed in sites with a known past history of direct use of asbestos (among men) such as Balangero (SIR 197.1, 95% CI 82.0-473.6), Casale Monferrato (SIR 910.7, 95% CI 816.5-1012.8), and Broni (SIR 1288.5, 95% CI 981.9-1691.0), in sites with shipyards and harbors (eg, Trieste, La Spezia, Venice, and Leghorn), and in settings without documented direct use of asbestos. The analysis ranked the sites of Broni and Casale Monferrato (both genders) and Biancavilla (only for women) the highest. Conclusions The present study confirms that asbestos pollution is a risk for people living in polluted areas, due to not only occupational exposure in industrial settings with direct use of asbestos but also the presence of asbestos in the environment. Epidemiological surveillance of asbestos-related diseases is a fundamental tool for monitoring the health profile in NPCS.
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Affiliation(s)
- Alessandra Binazzi
- Department of Occupational and Environmental Medicine, Epidemiology, Hygiene. National Institute for Insurance against Accidents at Work (INAIL), Via Stefano Gradi 55, 00143 Rome, Italy.
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Pirastu R, Ranucci A, Consonni D, De Santis M, Bruno C, Conti S, Fazzo L, Iavarone I, Pasetto R, Zona A, Magnani C, Comba P. [Reference rates for cohort studies in Italy: an essential tool in occupational and residential cohort studies]. Med Lav 2016; 107:473-477. [PMID: 27976665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 11/07/2016] [Indexed: 06/06/2023]
Abstract
The cohort study aims to test the hypothesis of an association between specific exposure/s and adverse health outcomes. The cohorts include the subjects who experience the exposure/s and are followed up over time to ascertain the health outcomes. This contribution presents the database for the analysis of mortality studies which is made available for public institutions carrying out cohort studies in Italy. The rates were computed from official mortality data from ISTAT. The database contains 141 causes or groups of causes for the years 1970-2012 ensuring correspondence with subsequent editions of ICD (International Classification of Diseases) VIII, IX and X.
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Fazzo L, Menegozzo S, Soggiu ME, De Santis M, Santoro M, Cozza V, Brangi A, Menegozzo M, Comba P. Mesothelioma incidence in the neighbourhood of an asbestos-cement plant located in a national priority contaminated site. Ann Ist Super Sanita 2016; 50:322-7. [PMID: 25522071 DOI: 10.4415/ann_14_04_05] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND An epidemic of asbestos-related disease is ongoing in most industrialized countries, mainly attributable to past occupational exposure but partly due to environmental exposure. In this perspective, the incidence of pleural mesothelioma close to a former asbestos-cement plant in a national contaminated site was estimated. METHODS The census-tracts interested by atmospheric dispersion of facilities in the contaminated site were identified. Two subareas with different estimated environmental asbestos impact were distinguished. An ecological study at micro-geographic level was performed. The standardized incidence ratios (SIR) for study area and the two subareas, in comparison with region and municipality were computed. The standardized incidence rate ratio (IRR) between the two subareas was computed. RESULTS Mesothelioma incidence in the study area was increased: 46 cases were observed with respect to 22.23 expected (SIR: 2.02). The increase was confirmed in analysis considering only the subjects without an occupationally exposure to asbestos: 19 cases among men (SIR = 2.48; 95% CI: 1.49-3.88); 11 case among women (SIR = 1.34; 95% CI: 0.67-2.40). The IRR between the two subareas is less than one in overall population considering all age-classes and of 3 fold (IRR = 3.14, 95% CI: 0.65-9.17) in the age-classes below 55 years. CONCLUSIONS The findings indicate an increased incidence of pleural mesothelioma in the neighbourhood of asbestos-cement plant, and a possible etiological contribution of asbestos environmental exposure in detected risks.
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Affiliation(s)
- Lucia Fazzo
- Dipartimento di Ambiente e Connessa Prevenzione Primaria, Istituto Superiore di Sanità, Rome, Italy.E-mail:
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Zona A, Fazzo L, Binazzi A, Bruno C, Corfiati M, Comba P, Conti S, Menegozzo S, Nicita C, Pasetto R, Pirastu R, Marinaccio A. [SENTIERI-ReNaM: Discussion and concluding remarks]. Epidemiol Prev 2016; 40:105-108. [PMID: 27825200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
SENTIERI-ReNaM Project analysed the incidence of malignant mesothelioma (MM) for the period 2000-2011 in 39 National Priority Contaminated Sites (NPCSs), and assessed the overall impact of mesothelioma in different types of NPCSs. In the study period, 2,683 incident cases of malignant mesothelioma were recorded: 1,998 males (74.5%), 685 females (25.5%). Excluding cases with non attributable exposure and those non interviewed, exposure was identified in 1,926 cases (70% of all cases): 1,541 males (occupational exposure: 1,414; environmental exposure: 82), 385 females (occupational exposure: 103; environmental exposure: 141). Women experienced mainly environmental and domestic exposures to asbestos. Standard Incidence Ratio (SIR) excesses were observed in men in 27 out of 39 NPCSs and defects in the remaining 12; in women, 20 NPCSs showed SIR excesses, defects in 15; in 4 NPCSs no MM cases occurred among female population. The highest rates were found in NPCSs with asbestos-cement plants (Broni and Casale Monferrato), respectively, 98 per 100,000 per year and 68.6 in men, 72.1 and 45.8 in women. Excluding these two sites, the highest incidence rates were found in the group with harbours and shipyards, where the rates were, respectively, 13.2 among men and 2.5 among women. The results of this report will be communicated to national and local institutions, as well as to NPCSs resident populations.
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Affiliation(s)
- Amerigo Zona
- Dipartimento di ambiente e connessa prevenzione primaria, Istituto superiore di sanità, Roma
| | - Lucia Fazzo
- Dipartimento di ambiente e connessa prevenzione primaria, Istituto superiore di sanità, Roma
| | - Alessandra Binazzi
- Dipartimento di medicina, epidemiologia, igiene del lavoro e ambientale, Istituto nazionale per l'assicurazione contro gli infortuni sul lavoro, Roma
| | - Caterina Bruno
- Dipartimento di ambiente e connessa prevenzione primaria, Istituto superiore di sanità, Roma
| | - Marisa Corfiati
- Dipartimento di medicina, epidemiologia, igiene del lavoro e ambientale, Istituto nazionale per l'assicurazione contro gli infortuni sul lavoro, Roma
| | - Pietro Comba
- Dipartimento di ambiente e connessa prevenzione primaria, Istituto superiore di sanità, Roma
| | - Susanna Conti
- Ufficio di statistica, CNESPS, Istituto superiore di sanità, Roma
| | - Simona Menegozzo
- Istituto nazionale tumori, IRCCS "Fondazione G. Pascale", Napoli
| | - Carmela Nicita
- Registro tumori Ragusa - COR Sicilia, Dipartimento di prevenzione, ASP 7 Ragusa
| | - Roberto Pasetto
- Dipartimento di ambiente e connessa prevenzione primaria, Istituto superiore di sanità, Roma
| | - Roberta Pirastu
- Dipartimento di biologia e biotecnologie "Charles Darwin", Sapienza Università di Roma
| | - Alessandro Marinaccio
- Dipartimento di medicina, epidemiologia, igiene del lavoro ed ambientale, Istituto nazionale per l'assicurazione contro gli infortuni sul lavoro, Roma
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Comba P, Zona A, Pirastu R, Bruno C, Fazzo L, Pasetto R, Binazzi A, Corfiati M, Marinaccio A. [SENTIERI-ReNaM: Rationale and objectives]. Epidemiol Prev 2016; 40:13-15. [PMID: 27825196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The purpose of the SENTIERI-ReNaM Project is to analyse the incidence of mesothelioma in Italian National Priority Contaminated Sites (NPCSs) in order to estimate the health impact of asbestos on resident populations, disentangling the role of occupational and environmental exposures. SENTIERI Project has provided the relevant information on geographic and demographic structure of NPCSs and on existing sources of contamination. The Italian National Mesothelioma Registry (ReNaM), that covers the whole country through its Regional Operational Centres (CORs), has made available the procedures for estimating the incidence of mesothelioma in NPCSs and for assessing occupational and environmental asbestos exposure of the individual cases. The synergy between these two epidemiological surveillance systems lay also the ground for communication programmes with the affected communities.
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Affiliation(s)
- Pietro Comba
- Dipartimento di ambiente e connessa prevenzione primaria, Istituto superiore di sanità, Roma
| | - Amerigo Zona
- Dipartimento di ambiente e connessa prevenzione primaria, Istituto superiore di sanità, Roma.
| | - Roberta Pirastu
- Dipartimento di biologia e biotecnologie "Charles Darwin", Sapienza Università di Roma
| | - Caterina Bruno
- Dipartimento di ambiente e connessa prevenzione primaria, Istituto superiore di sanità, Roma
| | - Lucia Fazzo
- Dipartimento di ambiente e connessa prevenzione primaria, Istituto superiore di sanità, Roma
| | - Roberto Pasetto
- Dipartimento di ambiente e connessa prevenzione primaria, Istituto superiore di sanità, Roma
| | - Alessandra Binazzi
- Dipartimento di medicina, epidemiologia, igiene del lavoro e ambientale, Istituto nazionale per l'assicurazione contro gli infortuni sul lavoro, Roma
| | - Marisa Corfiati
- Dipartimento di medicina, epidemiologia, igiene del lavoro e ambientale, Istituto nazionale per l'assicurazione contro gli infortuni sul lavoro, Roma
| | - Alessandro Marinaccio
- Dipartimento di medicina, epidemiologia, igiene del lavoro ed ambientale, Istituto nazionale per l'assicurazione contro gli infortuni sul lavoro, Roma
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Conti S, Comba P, Manno V, Minelli G, Nicita C, Pasetto R, Fazzo L, Zona A, Bruno C. [SENTIERI-ReNaM: Integration of incidence, mortality, and hospitalization: general remarks and a focus on mesothelioma]. Epidemiol Prev 2016; 40:109-115. [PMID: 27825201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The integration of current data sources is now a practice widely used in epidemiology, especially in the environmental field. To better describe the health profile of populations residing in proximity to areas characterized by a "strong environmental pressure", the combined use of multiple indicators (i.e., mortality, hospitalization, cancer incidence) is recommended. To choose an indicator is complex, as indicators should be contextualized and they need to be related to the several issues involved in the studied pathology. This chapter explores the general considerations that are to be addressed both at the time of the study design, during the selection of outcomes and of the proper data sources, and at the time of the discussion of the results, when different and complementary data are compared. A special focus is devoted to the case of mesothelioma.
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Affiliation(s)
- Susanna Conti
- Ufficio di statistica, CNESPS, Istituto superiore di sanità, Roma
| | - Pietro Comba
- Dipartimento di ambiente e connessa prevenzione primaria, Istituto superiore di sanità, Roma
| | - Valerio Manno
- Ufficio di statistica, Istituto superiore di sanità, Roma
| | - Giada Minelli
- Ufficio di statistica, Istituto superiore di sanità, Roma
| | - Carmela Nicita
- Registro tumori Ragusa - COR Sicilia, Dipartimento di prevenzione, ASP 7 Ragusa
| | - Roberto Pasetto
- Dipartimento di ambiente e connessa prevenzione primaria, Istituto superiore di sanità, Roma
| | - Lucia Fazzo
- Dipartimento di ambiente e connessa prevenzione primaria, Istituto superiore di sanità, Roma
| | - Amerigo Zona
- Dipartimento di ambiente e connessa prevenzione primaria, Istituto superiore di sanità, Roma
| | - Caterina Bruno
- Dipartimento di ambiente e connessa prevenzione primaria, Istituto superiore di sanità, Roma
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Pasetto R, Fazzo L, Zona A, Bruno C, Pirastu R, Binazzi A, Corfiati M, Silvestri S, Comba P, Marinaccio A. [SENTIERI-ReNaM: Burden of disease from mesothelioma in national priority contaminated sites in Italy]. Epidemiol Prev 2016; 40:99-104. [PMID: 27825199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND in Italy, National Priority Contaminated Sites (NPCSs) are defined as of concern for remediation; most of them are sites with a long-lasting industrial activity. OBJECTIVE the study aims to estimate the burden of disease from mesothelioma in NPCSs. DESIGN mesothelioma incidence in the period 2000-2011 was estimated for the populations residing in the 39 Italian NPCSs. Data were taken from the Italian National Mesothelioma Registry (ReNaM). NPCSs were ranked into risk groups (RGs) on the basis of the presence of the following asbestos-exposing activities: 1. asbestos-cement plants; 2. asbestos mines; 3. harbours with shipyards; 4. illegal dumping sites containing asbestos; 5. petrochemicals and/or refineries, and/or steel plants; 6. chemical plants and/or landfills without explicit mention of asbestos. For the population residing in each NPCS, crude rates per 100,000 per year and number of observed minus expected cases (Obs-Exp) by gender were computed. Expected cases were calculated using the age-class rates of a reference population (the geographical macroarea of every NPCS). For every RG, the meta-analytic estimate of the attributable proportion (AP), i.e., the proportion of cases attributable to the local context, was computed, being the AP for each NPCS expressed as (Obs-Exp/Obs) x100. RESULTS the total number of mesothelioma cases estimated in the considered period of 12 years is 2,741 (2,048 males, 693 females). The total number of Obs-Exp cases was 1,531 (1,178 in males, 353 in females). In males, crude rate ranges from 71.5 in the RG1 to 3.0 in RG4, while in females it ranges from 48.4 in RG1 to 0.6 in RG4. In males, AP in RGs from 1 to 3 is over 65%, in RG4 is 59%, in RG5 is 30%, in RG6 is -14%. AP in females gradually drops from 95% in RG1 to -64% in RG6. CONCLUSIONS the burden of mesothelioma in populations residing in NPCSs is high, with an AP gradient consistent with the a priori RG. This burden impacts on females in a different way: rates are lower than male ones; AP is similar to male ones in the RGs 1 and 3.
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Affiliation(s)
- Roberto Pasetto
- Dipartimento di ambiente e connessa prevenzione primaria, Istituto superiore di sanità, Roma
| | - Lucia Fazzo
- Dipartimento di ambiente e connessa prevenzione primaria, Istituto superiore di sanità, Roma
| | - Amerigo Zona
- Dipartimento di ambiente e connessa prevenzione primaria, Istituto superiore di sanità, Roma.
| | - Caterina Bruno
- Dipartimento di ambiente e connessa prevenzione primaria, Istituto superiore di sanità, Roma
| | - Roberta Pirastu
- Dipartimento di biologia e biotecnologie "Charles Darwin", Sapienza Università di Roma
| | - Alessandra Binazzi
- Dipartimento di medicina, epidemiologia, igiene del lavoro e ambientale, Istituto nazionale per l'assicurazione contro gli infortuni sul lavoro, Roma
| | - Marisa Corfiati
- Dipartimento di medicina, epidemiologia, igiene del lavoro e ambientale, Istituto nazionale per l'assicurazione contro gli infortuni sul lavoro, Roma
| | - Stefano Silvestri
- Collaboratore Istituto per lo studio e la prevenzione oncologica, Firenze
| | - Pietro Comba
- Dipartimento di ambiente e connessa prevenzione primaria, Istituto superiore di sanità, Roma
| | - Alessandro Marinaccio
- Dipartimento di medicina, epidemiologia, igiene del lavoro ed ambientale, Istituto nazionale per l'assicurazione contro gli infortuni sul lavoro, Roma
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Marinaccio A, Binazzi A, Comba P, Corfiati M, Fazzo L, Bruno C, Pirastu R, Pasetto R, Zona A. [SENTIERI-ReNaM: Materials and methods]. Epidemiol Prev 2016; 40:16-18. [PMID: 27825197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
In the framework of SENTIERI Project, this study is aimed to identify excess risks of malignant mesothelioma (MM) in Italian National Priority Contaminated Sites (NPCSs) included in the national environmental remediation programme and to discuss the results by means of data available from the Italian National Mesothelioma Registry (ReNaM). Re- NaM has a regional structure with Regional Operational Centres (CORs) in charge of identifying mesothelioma incident cases and defining the asbestos exposure modalities thought an individual questionnaire. Starting from the 44 NPCSs selected in SENTIERI Project, we excluded Calabria and Sardinia Regions from the analyses (3 NPCSs). Furthermore, for 2 sites (Emarese in Valle d'Aosta and Tito in Basilicata) no incident MM cases have been detected in the considered period. Incident cases of MM and Standardized Incidence Ratios (SIR), with corresponding 90% confidence intervals, have been estimated in each NPCS, for both gender, in the period 2000-2011. Age-standardized rates of Italian geographical macro-areas (North- East, North-West, Centre, South and Islands) have been used to estimate expected cases. For every analyzed site, the occupational and non-occupational asbestos exposure modalities are discussed.
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Affiliation(s)
- Alessandro Marinaccio
- Dipartimento di medicina, epidemiologia, igiene del lavoro ed ambientale, Istituto nazionale per l'assicurazione contro gli infortuni sul lavoro, Roma
| | - Alessandra Binazzi
- Dipartimento di medicina, epidemiologia, igiene del lavoro e ambientale, Istituto nazionale per l'assicurazione contro gli infortuni sul lavoro, Roma
| | - Pietro Comba
- Dipartimento di ambiente e connessa prevenzione primaria, Istituto superiore di sanità, Roma
| | - Marisa Corfiati
- Dipartimento di medicina, epidemiologia, igiene del lavoro e ambientale, Istituto nazionale per l'assicurazione contro gli infortuni sul lavoro, Roma
| | - Lucia Fazzo
- Dipartimento di ambiente e connessa prevenzione primaria, Istituto superiore di sanità, Roma
| | - Caterina Bruno
- Dipartimento di ambiente e connessa prevenzione primaria, Istituto superiore di sanità, Roma
| | - Roberta Pirastu
- Dipartimento di biologia e biotecnologie "Charles Darwin", Sapienza Università di Roma
| | - Roberto Pasetto
- Dipartimento di ambiente e connessa prevenzione primaria, Istituto superiore di sanità, Roma
| | - Amerigo Zona
- Dipartimento di ambiente e connessa prevenzione primaria, Istituto superiore di sanità, Roma.
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Binazzi A, Zona A, Marinaccio A, Bruno C, Corfiati M, Fazzo L, Menegozzo S, Nicita C, Pasetto R, Pirastu R, De Santisi M, Comba P. [SENTIERI-ReNaM: Results]. Epidemiol Prev 2016; 40:19-98. [PMID: 27825198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Mesothelioma incidence has been analyzed in National Priority Contaminated Sites (NPCSs) to estimate the health impact of asbestos exposure on resident people. The burden of professional and environmental exposures has been identified through data of the Regional Operational Centres (CORs), made available by the Italian National Mesothelioma Registry (ReNaM). An excess of mesothelioma incidence is confirmed in sites with a known past history of direct use of asbestos, such as Balangero, Casale Monferrato, Broni, Bari-Fibronit, and in coastal areas, where shipyards, harbours and other industries that involved a wide use of asbestos are represented (e.g., Trieste, La Spezia, Venice, and Leghorn). An excess of mesothelioma has been observed in settings where the asbestos is not mentioned as contaminant in the decree that included these sites among NPCSs, such as Cengio and Saliceto in Northern Italy; Falconara Marittima and the Bacino Idrografico Fiume Sacco in the Central Italy; the Litorale Domizio Flegreo and Agro Aversano, Milazzo, and Gela in the Southern Italy. Observed excess in the various NPCSs confirms the large-scale occurrence in contaminated Italian sites of a significant amount of total mesothelioma cases observed at national level. The analysis of occupational risk in epidemiological studies with an ecological design helps in defining the contribution of different factors to the overall risk.
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Affiliation(s)
- Alessandra Binazzi
- Dipartimento di medicina, epidemiologia, igiene del lavoro e ambientale, Istituto nazionale per l'assicurazione contro gli infortuni sul lavoro, Roma
| | - Amerigo Zona
- Dipartimento di ambiente e connessa prevenzione primaria, Istituto superiore di sanità, Roma.
| | - Alessandro Marinaccio
- Dipartimento di medicina, epidemiologia, igiene del lavoro ed ambientale, Istituto nazionale per l'assicurazione contro gli infortuni sul lavoro, Roma
| | - Caterina Bruno
- Dipartimento di ambiente e connessa prevenzione primaria, Istituto superiore di sanità, Roma
| | - Marisa Corfiati
- Dipartimento di medicina, epidemiologia, igiene del lavoro e ambientale, Istituto nazionale per l'assicurazione contro gli infortuni sul lavoro, Roma
| | - Lucia Fazzo
- Dipartimento di ambiente e connessa prevenzione primaria, Istituto superiore di sanità, Roma
| | - Simona Menegozzo
- Istituto nazionale tumori, IRCCS "Fondazione G. Pascale", Napoli
| | - Carmela Nicita
- Registro tumori Ragusa - COR Sicilia, Dipartimento di prevenzione, ASP 7 Ragusa
| | - Roberto Pasetto
- Dipartimento di ambiente e connessa prevenzione primaria, Istituto superiore di sanità, Roma
| | - Roberta Pirastu
- Dipartimento di biologia e biotecnologie "Charles Darwin", Sapienza Università di Roma
| | - Marco De Santisi
- Dipartimento ambiente e connessa prevenzione primaria, Istituto superiore di sanità, Roma
| | - Pietro Comba
- Dipartimento di ambiente e connessa prevenzione primaria, Istituto superiore di sanità, Roma
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Fazzo L, Carere M, Tisano F, Bruno C, Cernigliaro A, Cicero MR, Comba P, Contrino ML, De Santis M, Falleni F, Ingallinella V, Madeddu A, Marcello I, Regalbuto C, Sciacca G, Soggiu ME, Zona A. Cancer incidence in Priolo, Sicily: a spatial approach for estimation of industrial air pollution impact. Geospat Health 2016; 11:320. [PMID: 27087035 DOI: 10.4081/gh.2016.320] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Revised: 10/20/2015] [Accepted: 10/20/2015] [Indexed: 05/23/2023]
Abstract
The territory around the industrial Sicilian area of Priolo, Italy, has been defined as a contaminated site (CS) of national priority for remediation because of diffuse environmental contamination caused by large industrial settlements. The present study investigates the spatial distribution of cancer into the CS territory (period 1999-2006). Different geographical methods used for the evaluation of the impact of industrial air pollutants were adopted. Using the database of Syracuse Province Cancer Registry, gender-specific standardised incidence ratios were calculated for 35 tumour sites for the CS overall and for each municipality included in the CS. A cluster analysis for 17 selected neoplasms was performed at micro-geographical level. The identification of the priority index contaminants (PICs) present in environmental matrices and a review of their carcinogenicity have been performed and applied in the interpretation of the findings. The area has a higher cancer incidence with respect to the provincial population, in particular excess is registered among both genders of lung, bladder and breast cancers as well as skin melanoma and pleural mesothelioma and there is an a priori evidence of association with the exposure to PICs. The study highlights the need to provide different approaches in CSs where several exposure pathways might be relevant for the population. The presence of potential sources of asbestos exposure deserves specific concern.
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Affiliation(s)
- Lucia Fazzo
- Department of Environment and Primary Prevention, National Institute of Health, Rome.
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Comba P, Ricci P, Iavarone I, Pirastu R, Buzzoni C, Fusco M, Ferretti S, Fazzo L, Pasetto R, Zona A, Crocetti E. Cancer incidence in Italian contaminated sites. Ann Ist Super Sanita 2015; 50:186-91. [PMID: 24968919 DOI: 10.4415/ann_14_02_13] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
INTRODUCTION The incidence of cancer among residents in sites contaminated by pollutants with a possible health impact is not adequately studied. In Italy, SENTIERI Project (Epidemiological study of residents in National Priority Contaminated Sites, NPCSs) was implemented to study major health outcomes for residents in 44 NPCSs. METHODS The Italian Association of Cancer Registries (AIRTUM) records cancer incidence in 23 NPCSs. For each NPCSs, the incidence of all malignant cancers combined and 35 cancer sites (coded according to ICD-10), was analysed (1996-2005). The observed cases were compared to the expected based on age (5-year period,18 classes), gender, calendar period (1996-2000; 2001-2005), geographical area (North-Centre and Centre-South) and cancer sites specific rates. Standardized Incidence Ratios (SIR) with 90% Confidence Intervals were computed. RESULTS In both genders an excess was observed for overall cancer incidence (9% in men and 7% in women) as well as for specific cancer sites (colon and rectum, liver, gallblad-der, pancreas, lung, skin melanoma, bladder and Non Hodgkin lymphoma). Deficits were observed for gastric cancer in both genders, chronic lymphoid leukemia (men), malignant thyroid neoplasms, corpus uteri and connective and soft-tissue tumours and sarcomas (women). DISCUSSION This report is, to our knowledge, the first one on cancer risk of residents in NPCSs. The study, although not aiming to estimate the cancer burden attributable to the environment as compared to occupation or life-style, supports the credibility of an etiologic role of environmental exposures in contaminated sites. Ongoing analyses focus on the interpretation of risk factors for excesses of specific cancer types overall and in specific NPCSs in relation to the presence of carcinogenic pollutants.
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Affiliation(s)
- Pietro Comba
- Dipartimento di Ambiente e Connessa Prevenzione Primaria, Istituto Superiore di Sanità, Rome, Italy. E-mail:
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Bruno C, Tumino R, Fazzo L, Cascone G, Cernigliaro A, De Santis M, Giurdanella MC, Nicita C, Rollo PC, Scondotto S, Spata E, Zona A, Comba P. Incidence of pleural mesothelioma in a community exposed to fibres with fluoro-edenitic composition in Biancavilla (Sicily, Italy). Ann Ist Super Sanita 2015; 50:111-8. [PMID: 24968908 DOI: 10.4415/ann_14_02_02] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Amphibolic fibres with fluoro-edenitic composition characterize Biancavilla soil, including the major quarry from which building materials have been extensively extracted. These fibres induce mesothelioma in experimental animals and their in vitro biological action is similar to that of crocidolite. MATERIALS AND METHODS Malignant mesothelioma case series and incidence were examined to evaluate the disease burden on Biancavilla inhabitants. RESULTS The incidence of pleural mesothelioma in Biancavilla is steadily higher than in the Sicilian Region, risk estimates are more elevated in women than in men, the most affected age class is constituted by subjects aged less than 50. DISCUSSION AND CONCLUSIONS Environmental exposure to fibres with fluoro-edenitic composition appears to be causally related to the elevated mesothelioma occurrence in Biancavilla. In this frame, environmental clean-up is the main goal to be pursued in public health terms. A contribution of scientific research to public health decision making with respect to priority setting for environmental clean-up can derive from some further selected epidemiological investigations.
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Affiliation(s)
- Caterina Bruno
- Dipartimento di Ambiente e Connessa Prevenzione Primaria, Istituto Superiore di Sanità, Rome, Italy. E-mail:
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Benedetti M, Fazzo L, Buzzoni C, Comba P, Magnani C, Fusco M. Incidence of soft tissue sarcomas in an Italian area affected by illegal waste dumping sites. Arch Environ Occup Health 2015; 70:154-9. [PMID: 24219564 DOI: 10.1080/19338244.2013.845135] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
The aim of the present study was to investigate the possible association between occurrence of soft tissue sarcomas (STS) and residence in an Italian area affected by illegal practices of dumping and setting fire to both hazardous and solid urban wastes. Standardized incidence ratios (SIRs) were computed separately for STS and some specific STS subtypes. The analysis was performed for the total population and for specific age groups, namely, children, adolescents, and adults. In adults, no significant increase in STS was found other than for gastrointestinal stromal tumors in males. A nonsignificant increase in incidence of STS was observed for male children and female adolescents. The results of the present study do not allow conclusions for a causal association. In the absence of previous epidemiological studies on this issue, further investigations are needed.
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Affiliation(s)
- Marta Benedetti
- a Unit of Environmental Epidemiology, Department of Environment and Primary Prevention, National Institute of Health , Rome , Italy
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Comba P, Fazzo L, Musmeci L. [Healthcare and wastes: research, public health and communication]. Epidemiol Prev 2014; 38:303-304. [PMID: 25387744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- Pietro Comba
- Dipartimento ambiente e connessa prevenzione primaria, Istituto superiore di sanità, Roma.
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Comba P, Ricci P, Iavarone I, Conti S, Bianchi F, Biggeri A, Fazzo L, Forastiere F, Martuzzi M, Musmeci L, Pasetto R, Pirastu R, Zona A, Crocetti E. [SENTIERI Project: rationale and objectives]. Epidemiol Prev 2014; 38:15-20. [PMID: 24986498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The Istituto Superiore di Sanità (National Institute of Health-ISS), in partnership with a network of Italian national and regional scientific institutions, initiated the SENTIERI Project (Epidemiological Study of Residents in Italian Contaminated Sites-NPCSs), the objectives, methods and initial results of which were published by Epidemiologia & Prevenzione in 2010 and 2011. In the course of 2013, some of the SENTIERI Project findings were published in international scientific journals, and the "SENTIERI approach" was among those sanctioned by the World Health Organization to conduct an initial description of the health status of residents of contaminated sites. The present Report, set up jointly by ISS and the Italian Network of Cancer Registries (AIRTUM), as anticipated in the 2011 Report, aims to provide, for each of the 18 National Priority Contaminated Sites included in the SENTIERI Project where the Italian Association of Cancer Registries is active, a mortality update to 2010, analyses of cancer incidence (1996-2005 in 17 NPCSs) and of hospital discharges (2005-2010), as is explained in detail in Chapter 2, pertaining to the project's materials and methods. The results of the analyses for each NPCS are presented in Chapter 3, while Chapter 4 includes a critical appraisal, a discussion of the methodological approach and a series of concluding remarks. The second section of the Report takes an in-depth look at important issues of public health and scientific research in contaminated sites. This Report represents an important step towards implementing a permanent epidemiological surveillance system in Italy's contaminated sites, the ultimate goal of the SENTIERI Project.
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Affiliation(s)
- Pietro Comba
- Dipartimento ambiente e connessa prevenzione primaria, Istituto superiore di sanità, Roma.
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Conti S, Crocetti E, Buzzoni C, Comba P, Fazzo L, Iavarone I, Manno V, Minelli G, Pasetto R, Pirastu R, Ricci P, Zona A, Fusco M. [SENTIERI Project: materials and methods]. Epidemiol Prev 2014; 38:21-28. [PMID: 24986499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The Report considers three health outcomes - mortality, cancer incidence and hospital discharges - studied using homogenous methods and using data from official sources, namely the National Institute of Statistics (Istat), Italian Network of Cancer Registries (AIRTUM) and the Health Ministry. The timeframes of observation are: 2003-2010 for mortality, 1996-2005 for cancer incidence and 2005-2010 for hospital discharges. The causes of death are those examined by the SENTIERI Project. Hospital discharges are analysed with reference to the main diagnosis. The study of cancer incidence applies to the sites selected by AIRTUM. Statistical parameters (SMR, Standardized Mortality Ratio; SIR, Standardized Incidence Ratio; SHR, Standardized Hospitalization Ratio) were computed with a 90% confidence interval; the estimators were adjusted for age and socioeconomic status.
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Affiliation(s)
- Susanna Conti
- Ufficio di statistica, CNESPS, Istituto superiore di sanità, Roma.
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Crocetti E, Pirastu R, Buzzoni C, Minelli G, Manno V, Bruno C, Fazzo L, Iavarone I, Pasetto R, Ricci P, Zona A, Conti S, Comba P. [SENTIERI Project: results]. Epidemiol Prev 2014; 38:29-124. [PMID: 24986500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Of the 18 National Priority Contaminated Sites (NPCSs) analysed in this Report, some have a single source of environmental contamination (such as fluoro-edenite in Biancavilla). In most cases, however, we are looking at multiple heterogeneous sources of contamination. In this respect, the a priori causal evaluation of the association between diseases and environmental exposures in NPCSs, based on epidemiological evidence, can help trace the health impact back to specific types of environmental exposure. There are several cases in which the project's findings have been consistent with a priori evidence: stomach cancer (both genders, excess cancer incidence) in the Fidenza NPCS; stomach cancer (women, excess mortality, cancer incidence and hospital discharges) in the Laguna di Grado e Marano NPCS; excess hospitalisation from respiratory diseases in Brescia-Caffaro, Milazzo and Terni Papigno NPCSs; excesses for non-Hodgkin lymphomas and melanoma (incidence and hospitalisation in men and women) and breast cancer (incidence and hospital discharges, women) in Brescia-Caffaro NPCS. In preorder to properly evaluate the population's health profile, we must also observe whether results remain consistent for all three health outcomes or in both genders. The first is the case of excess mortality, cancer incidence and hospital discharges for bladder cancer (men) in Porto Torres and diseases of the urinary tract in the Basso bacino del fiume Chienti NPCS). Gender consistency is observed, for instance, for all cancer in Bolzano, Porto Torres, Venice, Litorale Domizio Flegreo, Priolo, and Taranto, for all causes in Taranto, Litorale Domizio Flegreo and Trieste. The health impact in the various NPCSs needs to be considered carefully and used as a springboard for further analytical research that could confirm and explain causal links to specific environmental exposures. The observations can, however, already be considered as a basis for mandatory primary prevention measures.
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Affiliation(s)
- Emanuele Crocetti
- SC Epidemiologia clinica e descrittiva, Istituto per lo studio e la prevenzione oncologica-ISPO, Firenze.
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Pirastu R, Ricci P, Comba P, Bianchi F, Biggeri A, Conti S, Fazzo L, Forastiere F, Iavarone I, Martuzzi M, Musmeci L, Pasetto R, Zona A, Crocetti E. [SENTIERI Project: discussion and conclusions]. Epidemiol Prev 2014; 38:125-133. [PMID: 24986501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The SENTIERI Project represents the first comprehensive analysis of the health impact of residence in National Priority Contaminated Sites (NPCSs). For the first time, it considers three distinct health outcomes: mortality (2003-2010), cancer incidence (1996- 2005) and hospital discharges (2005-2010). The Report includes a commentary explaining methodology and approach, as well as remarks on the causal association between environmental exposures and investigated health outcomes based on the a priori assessments of the epidemiological evidence; the main implications for public health and scientific research priorities are also presented. The approach put forward by SENTIERI was among those sanctioned by the World Health Organization to conduct an initial description of the health status of residents of contaminated sites. Results relating to individual diseases that can be traced back to a single agent, such as asbestiform fibres, can be easily analysed. The Biancavilla NPCS (where the fluoro-edenite asbestiform fibre was found) displays excesses of pleural mesothelioma and its proxy, malignant pleural tumours, as does Priolo, where asbestos coexists with other pollutants. Increased risk was also recorded in NPCSs adjacent to the coast hosting harbour areas (such as Trieste, Taranto and Venice) or comprising industrial areas specialising in the production of chemicals (Laguna di Grado e Marano, Priolo and Venezia) and steel (Taranto, Terni, Trieste). Increases of pathologies, such as cancer and respiratory diseases, connected to more than one agent, in industrial sites with multiple and diverse sources of exposures, prove harder to interpret. There are also more complex cases in which results do not appear consistent in the three databases or by gender (such as lung cancer in Venice, where mortality and hospital discharges have only increased among women). In order to adequately examine these we must consider factors such as the appropriateness of the health outcome showing the increase, considering latency and the length of the observation period. Of further interest are results relating to diseases of the urinary tract such as kidney failure in the NPCSs of Basso bacino del fiume Chienti, Taranto, Milazzo and Priolo. Overall, the results discussed above are consistent with the previous findings pertaining to mortality for 1995-2002. The present analysis also introduces a new element - the study of cancer incidence and hospital discharges - which can tell us a great deal about diseases with high survival rates or non lethal ones. The first is the case of thyroid cancer, which presents increases in both databases and for both genders in a number of NPCSs (Brescia-Caffaro, Laghi di Mantova, Milazzo, Sassuolo- Scandiano and Taranto). The study of cancer incidence and hospital discharges also revealed cancer excesses for melanoma, breast cancer and non Hodgkin lymphoma in Brescia-Caffaro NPCS where PCBs (Polychlorinated biphenyl) are the site's main pollutant. PCBs, according to the 2013 evaluation of the International Agency for Research on Cancer, are ascertained human carcinogens for melanoma and probable carcinogens for breast cancer and non-Hodgkin lymphoma. The results pertaining to cancer incidence in the 17 NPCSs can also be presented using rankings by area or disease analyzed by a multivariate hierarchical Bayesian model. These rankings reveal an overlapping of credibility intervals, such that it is not possible to speak of a limited number of cancer sites or of certain NPCSs as being particularly affected. Every NPCS, therefore, must be considered individually and ordering them by ranking of cancer incidence wouldn't be appropriate. Data collected concerning some of the NPCSs in the context of the SENTIERI Project is so conclusive that remediation measures can immediately be put in place. This is the case in the Biancavilla and Brescia-Caffaro NPCSs. A similar conclusion can be drawn for complex locations such as Taranto, where, based on the results of SENTIERI Projects and the whole available information, we can safely conclude that exposure to environmental agents played an important role, allowing us to set in place 'Integrated evaluation of environmental and health impact procedures'. SENTIERI approach does not allow definitive causal assessments. However, as stated above, these results do provide a topic for further study without getting in the way of initiatives promoting urgent environmental remediation.
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Affiliation(s)
- Roberta Pirastu
- Dipartimento di biologia e biotecnologie Charles Darwin, Sapienza Università di Roma.
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Fazzo L, Minichilli F, Pirastu R, Bellino M, Falleni F, Comba P, Bianchi F. A meta-analysis of mortality data in Italian contaminated sites with industrial waste landfills or illegal dumps. Ann Ist Super Sanita 2014; 50:278-285. [PMID: 25292275 DOI: 10.4415/ann_14_03_10] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVES Adverse effects of waste management represent a public health issue. Mortality meta-analysis in Italian National Priority Contaminated Sites (NPCSs) with industrial waste landfills or illegal dumps is presented. METHODS 24 NPCSs include industrial waste landfills or illegal dumps. Class 1 (10 NPCSs with industrial waste landfills) and Class 2 (14 NPCSs with illegal dumps) were categorized. Random-effects model meta-analyses of Standardized Mortality Ratios non-adjusted (SMRs) and adjusted for Deprivation (DI-SMRs) computed for each CS (1995-2002) were performed for overall 24 NPCSs and the two classes. The North- Southern gradient was considered. RESULTS 24 CSs pooled-SMRs are significantly increased in both genders for cancer of liver (men: SMR=1.13; women: SMR=1.18), bladder (men: SMR=1.06; women: SMR=1.11), and for cirrhosis (men: SMR=1.09; women: SMR=1.13). In Class 2 the increase is confirmed in both genders for liver and bladder cancers and for cirrhosis and in men only for lung cancer. Congenital anomalies and adverse perinatal conditions are not increased. CONCLUSION The results are consistent with the hypothesis of adverse health effects of non-adequately managed hazardous waste. Causal interpretation is not allowed, but the meta-analytic approach provides more confidence in the findings.
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Affiliation(s)
- Lucia Fazzo
- Dipartimento di Ambiente e Connessa Prevenzione Primaria, Istituto Superiore di Sanità, Rome, Italy. E-mail:
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Fazzo L, Tancioni V, Polichetti A, Iavarone I, Vanacore N, Papini P, Farchi S, Bruno C, Pasetto R, Borgia P, Comba P. Morbidity Experience in Populations Residentially Exposed to 50 Hz Magnetic Fields: Methodology and Preliminary Findings of a Cohort Study. International Journal of Occupational and Environmental Health 2013; 15:133-42. [DOI: 10.1179/oeh.2009.15.2.133] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Fazzo L, Minelli G, De Santis M, Bruno C, Zona A, Marinaccio A, Conti S, Pirastu R, Comba P. Mesothelioma mortality surveillance and asbestos exposure tracking in Italy. Annali dell'Istituto Superiore di Sanità 2012; 48:300-10. [DOI: 10.4415/ann_12_03_11] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Lucia Fazzo
- Dipartimento di Ambiente e Connessa Prevenzione Primaria, Istituto Superiore di Sanità, Rome, Italy
| | - Giada Minelli
- Ufficio di Statistica, Istituto Superiore di Sanità, Rome, Italy
| | - Marco De Santis
- Dipartimento di Ambiente e Connessa Prevenzione Primaria, Istituto Superiore di Sanità, Rome, Italy
| | - Caterina Bruno
- Dipartimento di Ambiente e Connessa Prevenzione Primaria, Istituto Superiore di Sanità, Rome, Italy
| | - Amerigo Zona
- Dipartimento di Ambiente e Connessa Prevenzione Primaria, Istituto Superiore di Sanità, Rome, Italy
| | - Alessandro Marinaccio
- Dipartimento Medicina del Lavoro, Registro Nazionale dei Mesoteliomi, Istituto Nazionale per l’Assicurazione contro gli Infortuni sul Lavoro, Rome, Italy
| | - Susanna Conti
- Ufficio di Statistica, Istituto Superiore di Sanità, Rome, Italy
| | - Roberta Pirastu
- Dipartimento di Biologia e Biotecnologie “Charles Darwin”, Sapienza Università di Roma, Rome, Italy
| | - Pietro Comba
- Dipartimento di Ambiente e Connessa Prevenzione Primaria, Istituto Superiore di Sanità, Rome, Italy
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Fazzo L, De Santis M, Minelli G, Bruno C, Zona A, Marinaccio A, Conti S, Comba P. Pleural mesothelioma mortality and asbestos exposure mapping in Italy. Am J Ind Med 2012; 55:11-24. [PMID: 22025020 DOI: 10.1002/ajim.21015] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/04/2011] [Indexed: 11/05/2022]
Abstract
BACKGROUND An epidemic of asbestos-related diseases is ongoing worldwide. Mortality from malignant pleural neoplasms in Italy was analyzed, to estimate the health impact of asbestos at national and local level. METHODS Mortality from ICD-9 code 163 was considered, in the time-window 1995-2002, using National Bureau of Statistics data. National and regional standardized rates and municipal Standardized Mortality Ratios (SMR) were calculated. Municipal clusters were identified by applying Spatial Scan Statistics procedure. Relative risks (RR) express the ratio of risk within the cluster to the risk outside the cluster. RESULTS The national standardized annual mortality rate was 1.9 per 100,000. Significant clusters corresponded to asbestos-cement industries (Casale Monferrato: RR = 11.63), shipyards (Monfalcone, RR = 7.43), oil refineries (Falconara, RR = 2.52), petrochemical industries (Priolo, RR = 3.81). CONCLUSIONS The present study confirms malignant pleural neoplasms mortality as a suitable indicator of asbestos exposure at geographic level. In addition to asbestos-cement industries and shipyards, other industrial settings are associated with pleural neoplasm mortality.
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Affiliation(s)
- Lucia Fazzo
- Environmental Epidemiology Unit, Department of Environment and Primary Prevention, Istituto Superiore di Sanità, Rome, Italy.
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