Asbestos Exposure and Malignant Mesothelioma in Construction Workers-Epidemiological Remarks by the Italian National Mesothelioma Registry (ReNaM)

Our plain-English summary of Asbestos Exposure and Malignant Mesothelioma in Construction Workers-Epidemiological Remarks by the Italian National Mesothelioma Registry (ReNaM), by A. Binazzi, D. Di Marzio, M. Verardo, et al (International Journal of Environmental Research and Public Health, 2021).

The study

• Authors: A. Binazzi, D. Di Marzio, M. Verardo, E. Migliore, L. Benfatto, D. Malacarne, C. Mensi, D. Consonni, S. Eccher, G. Mazzoleni, V. Comiati, C. Negro, A. Romanelli, E. Chellini, A. Angelini, I. Grappasonni, G. Madeo, E. Romeo, A. Di Giammarco, F. Carrozza, I.F. Angelillo, D. Cavone, L. Vimercati, M. Labianca, F. Tallarigo, R. Tumino, M. Melis, M. Bonafede, A. Scarselli, A. Marinaccio, On Behalf Of The ReNaM Working Group
• Journal: International Journal of Environmental Research and Public Health
• Published: 2021;19(1)
• Cited by: 22 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Notwithstanding the ban in 1992, asbestos exposure for workers in the construction sector in Italy remains a concern. The purpose of this study is to describe the characteristics of malignant mesothelioma (MM) cases recorded by the Italian registry (ReNaM) among construction workers. Incident mesothelioma cases with a definite asbestos exposure have been analyzed. Characteristics of cases and territorial clusters of crude rates of MM in construction workers have been described, as well as the relation between asbestos use before the ban and the historical trend of workforce in the construction sector in Italy. ReNaM has collected 31,572 incident MM cases in the period from 1993 to 2018 and asbestos exposure has been assessed for 24,864 (78.2%) cases. An occupational exposure has been reported for 17,191 MM cases (69.1% of subjects with a definite asbestos exposure). Among them, 3574 had worked in the construction sector, with an increasing trend from 15.8% in the 1993-98 period to 23.9% in 2014-2018 and a ubiquitous territorial distribution. The large use of asbestos in construction sector before the ban makes probability of exposure for workers a real concern still today, particularly for those working in maintenance and removal of old buildings. There is a clear need to assess, inform, and prevent asbestos exposure in this sector.

In plain English

This study used Italy's national mesothelioma registry (ReNaM) to describe malignant mesothelioma cases among construction workers. The registry collected 31,572 cases diagnosed between 1993 and 2018. Asbestos exposure had been evaluated for 24,864 cases (78.8%). Of these, 17,191 (69.1%) had occupational exposure, and 3574 of those (20.8%) had worked in construction. Almost all the construction workers were men (99.4%), and 95.5% had pleural mesothelioma. Their median duration of exposure was 31.0 years, compared with 24.0 years for other occupationally exposed cases. Median latency was similar (50.0 versus 49.0 years). Among cases with an exposure evaluation, the construction share rose from 11.1% in 1993–98 to 16.4% in 2014–2018. Among occupationally exposed cases it rose from 15.8% to 23.9%. Among 2310 cases exposed only in construction, most exposures were in general building construction, with others in plumbing and electrical installation. Cases occurred across the whole country. The authors concluded that a substantial and increasing fraction of mesothelioma cases were construction workers. They called for training for workers maintaining and renovating old buildings. They noted that exposure assessment was qualitative and that coverage varied between regions.

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 analysis of cases in a national mesothelioma surveillance registry, with exposure histories gathered by standardized interview
• Who was studied: 31,572 malignant mesothelioma cases diagnosed in Italy from 1993 to 2018 and recorded by ReNaM. Exposure was evaluated for 24,864 of them, and 3574 were construction workers.
• Exposure: Occupational asbestos exposure in the construction sector (ATECO 1991 code 45), compared with other occupational exposure. No specific fiber types are named.
• Main results:
  • Of 24,864 cases with an exposure evaluation (78.8%), 17,191 (69.1%) had occupational exposure, and 3574 of these (20.8%) had worked in construction.
  • Among construction workers with mesothelioma, 99.4% were men, 68.4% were aged 65–84, and 95.5% had pleural mesothelioma.
  • Median duration of exposure was 31.0 years in construction workers, compared with 24.0 years in other occupationally exposed cases.
  • Age at diagnosis, age and year at first exposure, and median latency were similar between construction workers and other occupationally exposed cases. Median latency was 50.0 versus 49.0 years (Table 2).
  • Among cases with an exposure evaluation in each period, the proportion exposed in the construction sector rose from 11.1% in 1993–98 (224 of 2010, Table 1) to 16.4% in 2014–2018 (900 of 5504).
  • Among occupationally exposed cases, the proportion who had worked in construction rose from 15.8% in 1993–98 to 23.9% in 2014–2018.
  • From 2008, the construction workforce decreased while mesothelioma cases from the construction sector increased.
  • 2310 cases were exposed only in construction, accounting for 2454 exposures. These included plumbing (n = 283) and installation of electrical wiring and fittings (n = 114).
  • Crude mesothelioma rates in the construction sector, by municipality of residence, ranged from 0.02 to 22.73 cases per 100,000, distributed across the whole national territory.
• The authors' conclusion: The authors concluded that there is a substantial and increasing fraction of mesothelioma cases among construction workers, and that education and training are needed for workers in remediation, maintenance and renovation of old buildings.
• Limitations the authors state:
  • The regional centers did not start at the same time, which could have introduced bias.
  • The trend comparison should be interpreted with caution because of mesothelioma's long latency. Asbestos consumption figures also cover sectors other than construction.
  • Exposure assessment was qualitative and not fully consistent across regions. The share of collected exposure histories varied from 45% to 95% by region.
  • Municipality of residence at diagnosis was used as a proxy for place of exposure, which could bias the maps.
  • Potential over-reporting is a concern for the registry.

Topics

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

Medical terms in this study, explained in our Lexicon: Asbestos Exposure, Malignant Mesothelioma, Mesothelioma, Occupational Exposure.

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• Mesothelioma Risk Among Maritime Workers According to Job Title: Data From the Italian Mesothelioma Register (ReNaM) — L. Vimercati, D. Cavone, et al. (2023)
• Epidemiological patterns of asbestos exposure and spatial clusters of incident cases of malignant mesothelioma from the Italian national registry — M. Corfiati, A. Scarselli, et al. (2015)
• Pleural mesothelioma risk in the construction industry: a case-control study in Italy, 2000-2018 — S. Stella, D. Consonni, et al. (2023)
• Association between asbestos exposure and pericardial and tunica vaginalis testis malignant mesothelioma: a case-control study and epidemiological remarks — A. Marinaccio, D. Consonni, et al. (2020)
• Malignant mesothelioma due to non-occupational asbestos exposure from the Italian national surveillance system (ReNaM): epidemiology and public health issues — A. Marinaccio, A. Binazzi, et al. (2015)

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