Asbestos related diseases in Italy: an integrated approach to identify unexpected professional or environmental exposure risks at municipal level

Our plain-English summary of Asbestos related diseases in Italy: an integrated approach to identify unexpected professional or environmental exposure risks at municipal level, by A. Marinaccio, A. Scarselli, A. Binazzi, et al (International Archives of Occupational and Environmental Health, 2008).

The study

• Authors: A. Marinaccio, A. Scarselli, A. Binazzi, P. Altavista, S. Belli, M. Mastrantonio, R. Pasetto, R. Uccelli, P. Comba
• Journal: International Archives of Occupational and Environmental Health
• Published: 2008;81(8):993-1001
• Cited by: 15 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Purpose: Past intensive use of asbestos has implied severe public health consequences. Spatial distribution of deaths from malignant mesothelioma and of compensated cases for asbestos related diseases in Italy were compared to identify unexpected sources of asbestos exposure.

Methods: Mortality for malignant mesothelioma at municipal level and geographical clusters of compensated cases for asbestos related diseases, as proxy of industrial asbestos exposure, were identified in the period 1988-2001.

Results: Municipalities with at least four mesothelioma deaths and a statistically significant mortality excess were 148; and 53 out of them had no compensated case for asbestos-related diseases. Finally 22 of these lay outside of any aforementioned cluster, thus suggestive of a possible unrecognized exposure.

Conclusions: Availability long-term national figures and the different etiology of asbestos related diseases are the key features of this exercise that was applied to Italy, but can be replicated wherever registration systems of diseases related to long term exposure to asbestos are available.

In plain English

This was a descriptive study of geographic patterns in Italy. It aimed to find places where asbestos exposure might not have been recognized. For each of Italy's 8,010 municipalities, the authors looked at deaths from malignant neoplasm of the pleura (cancer of the lung lining) in 1988–2001, used as a stand-in for malignant mesothelioma. They compared these deaths with clusters of asbestosis cases compensated by the national workers' insurance institute (INAIL), used as a stand-in for heavy occupational exposure. Over the period there were 13,432 pleural cancer deaths and 4,125 compensated asbestosis cases. 148 municipalities had at least four deaths and a statistically significant excess, judged at the 90% confidence level. Of these, 53 had no compensated asbestosis or asbestos-related cancer case, and 22 of those lay outside the 25 km circle around every asbestosis cluster. These 22 municipalities had 133 deaths (87 men, 46 women). The authors concluded that the method can point to areas where unknown sources of exposure may be acting. They noted that pleural cancer deaths are only a proxy for mesothelioma, that compensation procedures may vary across Italy, and that unrecognized occupational sources could not be excluded.

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 geographic (municipal-level) study comparing mortality from malignant neoplasm of the pleura with clusters of compensated asbestosis cases
• Who was studied: All 8,010 Italian municipalities, men and women, 1988–2001: deaths from malignant neoplasm of the pleura (ISTAT data) and asbestosis and asbestos-related cancer cases compensated by INAIL
• Exposure: Asbestos exposure in general, with no fiber type specified for the analysis. Clusters of compensated asbestosis cases were used as a proxy for occupational exposure, and areas outside those clusters were treated as possibly involving unrecognized occupational, environmental or household exposure.
• Main results:
  • Across Italy in 1988–2001 there were 13,432 deaths from malignant neoplasm of the pleura (8,907 males, 4,525 females).
  • INAIL compensated 4,125 asbestosis cases (3,814 males, 311 females) and 2,182 asbestos-related cancer cases (2,095 males, 87 females) in the period.
  • 148 municipalities had at least four pleural cancer deaths and a statistically significant excess (group A). 53 of these had no compensated asbestosis or asbestos-related cancer case (group B).
  • Of the 53 group B municipalities, 31 lay within 25 km of the centre of the nearest asbestosis cluster, and their excess was considered 'partially explained'.
  • The remaining 22 municipalities lay outside any asbestosis cluster circle and had an 'unexplained' significant excess of pleural cancer deaths.
  • The 22 'unexplained' municipalities together had 133 pleural cancer deaths (87 in men, 46 in women), a male-to-female ratio of 1.90.
  • Among the 22 municipalities, the male-to-female ratio was 0.3 to 0.6 in four. The authors said such low ratios support the hypothesis of exposure that was not strictly occupational in these areas.
  • The deaths in the 22 municipalities were spread evenly over time: 66 in 1988–1994 and 67 in 1995–2001.
  • Nine of the 22 municipalities were on the islands of Sicily (five) and Sardinia (four).
• The authors' conclusion: The authors concluded that the study suggests a strategy for identifying areas where unknown sources of asbestos exposure may be acting and where further investigation should be done, and that it can be replicated where disease registration systems exist.
• Limitations the authors state:
  • Deaths from malignant neoplasm of the pleura were used as a proxy for malignant mesothelioma.
  • The agreement between pleural cancer deaths and mesothelioma deaths was assumed to be the same in every municipality.
  • INAIL is an administrative system, and procedures for compensating asbestosis may not have been applied equally across Italy.
  • Asbestosis cases registered until 1999 were linked to the municipality of the company where exposure occurred, not the worker's residence.
  • Some known areas of high local mesothelioma incidence due to tremolite exposure were not detected because of the time window used.
  • Occupational exposure sources not yet described could not be excluded in the 22 'unexplained' municipalities.

Mines named here

Asbestos mines this study is about. Each mine's page says who ran it, when it worked, and what it produced.

• Balangero mine, Balangero, about 20 km north of Turin, Piedmont

All asbestos mines

Topics

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

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

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