Asbestos Air Pollution: Description of a Mesothelioma Cluster Due to Residential Exposure from an Asbestos Cement Factory

Our plain-English summary of Asbestos Air Pollution: Description of a Mesothelioma Cluster Due to Residential Exposure from an Asbestos Cement Factory, by L. Vimercati, D. Cavone, M.C. Delfino, et al (International Journal of Environmental Research and Public Health, 2020).

The study

• Authors: L. Vimercati, D. Cavone, M.C. Delfino, A. Caputi, L. De Maria, S. Sponselli, V. Corrado, G.M. Ferri, G. Serio
• Journal: International Journal of Environmental Research and Public Health
• Published: 2020;17(8)
• Cited by: 12 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

The study describes a cluster of 71 malignant mesothelioma cases among Bari residents without asbestos exposure other than residential exposure. This small cohort, as expected, was composed of a majority of females (56.34%) with a M/F ratio of 0.8, ages ≤ 65 years old (52.11%) and the epithelioid morphological type (78.87%). Sixty-four subjects (90.14%) lived between 10 m and 1000 m from the asbestos cement factory (Fibronit), and the latency length was longer than 55 years for 25 subjects (35.21%). The adjusted risk (adjusted OR) of observing the epithelial form of mesothelioma among subjects living at small distances from Fibronit was high (OR = 1.870 (0.353-9.905)) for people living 550-1000 m from the site and for those living less than 550 m from the site (OR = 1.470 (0.262-8.248)). Additionally, the subjects with a high length of exposure showed a relevant risk of epithelioid mesothelioma both for 21-40 years of exposure (OR = 2.027 (0.521-7.890)) and more than 40 years of exposure (OR = 2.879 (0.651-12.736)). All of the estimates were high but not significant because this transitional study has a typically low power. The adjustment for latency showed the same trend. Using detailed information collected by the regional mesothelioma registry, this study provided evidence of a continuing health impact of the Fibronit asbestos cement factory in Bari on the resident population.

In plain English

This study described 71 Bari, Italy residents with malignant mesothelioma, listed in the regional registry, whose only identified asbestos exposure was living near the Fibronit asbestos cement factory. The factory used chrysotile (80%) and amosite and crocidolite (20%) from 1934 to 1985. Forty were women and 31 were men. Most had pleural mesothelioma and three had peritoneal mesothelioma. Sixty-four had lived within 1000 m of the factory and seven farther away (up to 3000 m). Average time from first exposure to diagnosis was 50.7 years for men and 51.1 for women. The authors compared the epithelioid tumor type (56 patients) with the other two types. Odds ratios were above 1 for living closer to the factory and for living near it longer, but none was statistically significant. The authors attributed this to low power. These comparisons were among patients only, not against people without mesothelioma. The authors concluded that the results confirm the association between mesothelioma and environmental pollution in Bari. They noted the small number of cases and the lack of past air measurements.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Descriptive study of a cluster of mesothelioma cases drawn from a population-based regional mesothelioma registry. It used univariate, multivariate (adjusted odds ratio), cluster and principal component analyses comparing tumor types within the cases.
• Who was studied: 71 malignant mesothelioma cases among Bari (Apulia, southern Italy) residents, identified from Apulia Mesothelioma Registry records from 1989 to 2019. All had no occupational, familial, domestic or leisure asbestos exposure.
• Exposure: Residential (environmental) exposure from living near the Fibronit asbestos cement factory in Bari. The factory used amphiboles (amosite and crocidolite, 20%) and chrysotile (80%) from 1934 to 1985. Exposure was measured by distance of residence from the factory and length of residence nearby.
• Main results:
  • Of the 71 cases, 31 were males and 40 were females (male to female ratio 0.8).
  • The cases had pleural mesothelioma: 56 epithelioid, 7 fibrous (sarcomatoid) and 8 biphasic. Three of the subjects had peritoneal mesothelioma, all epithelioid.
  • Distance from the factory among the 71 cases: 31 (43.6%) within 500 m, 33 (46.4%) between 500 and 1000 m, and 7 (9.8%) between 1000 and 3000 m.
  • Average latency (first exposure to diagnosis) was 50.7 years for males (range 23 to 73) and 51.1 years for females (range 20 to 81).
  • Average age at diagnosis was 65.0 years for males (range 50 to 89) and 65.2 for females (range 37 to 90).
  • Among the cases, the adjusted odds ratio of having the epithelioid type (compared with biphasic and sarcomatoid types, and with residents beyond 1000 m as reference) was 1.870 (0.353 to 9.905) for those living 550 to 1000 m from Fibronit. It was 1.470 (0.262 to 8.248) for those living less than 550 m away.
  • Among the cases, the adjusted odds ratio of the epithelioid type was 2.027 (0.521 to 7.890) for 21 to 40 years of exposure and 2.879 (0.651 to 12.736) for more than 40 years, compared with less than 21 years.
  • None of the adjusted estimates was statistically significant, which the authors attributed to the low power of the study.
  • Cluster analysis separated cases living more than 1000 m from the factory from those living less than 1000 m away.
  • Analysis of wind data from 1961 to 2010 found no prevalent wind direction.
• The authors' conclusion: The authors concluded that past asbestos use had serious public health consequences for Bari's inhabitants. They concluded that their results confirm the association between mesothelioma and environmental pollution in the city.
• Limitations the authors state:
  • Long latency period and small number of cases.
  • No analytical data on asbestos fiber concentrations in Bari's urban air from 1935 to 2018.
  • Low statistical power, so the estimates were not statistically significant.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Lung cancer, Mesothelioma.

Medical terms in this study, explained in our Lexicon: Mesothelioma Cluster, Asbestos-Cement, Malignant Mesothelioma, Asbestos Exposure, Epithelioid, Latency, Mesothelioma.

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