Burden of Mortality from Asbestos-Related Diseases in Italy

Our plain-English summary of Burden of Mortality from Asbestos-Related Diseases in Italy, by L. Fazzo, A. Binazzi, D. Ferrante, et al (International Journal of Environmental Research and Public Health, 2021).

The study

• Authors: L. Fazzo, A. Binazzi, D. Ferrante, G. Minelli, D. Consonni, L. Bauleo, C. Bruno, M. Bugani, M. De Santis, I. Iavarone, C. Magnani, E. Romeo, A. Zona, M. Alessi, P. Comba, A. Marinaccio
• Journal: International Journal of Environmental Research and Public Health
• Published: 2021;18(19)
• Cited by: 22 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

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.

In plain English

The authors estimated how many deaths in Italy each year were due to asbestos-related diseases. They described this as the first such estimate for Italy. They used national death records from 2010 to 2016 for mesothelioma and asbestosis. They estimated asbestos-related lung cancer deaths from Italian population-based case-control studies and from a pool of 43 Italian cohorts of workers in high-exposure sectors. In 2010 to 2016, 10,607 people (7660 men, 2947 women) died of mesothelioma and 405 (361 men, 44 women) of asbestosis. About 11% of male and 1% of female lung cancer deaths were estimated attributable to asbestos. In total, the authors estimated about 4400 asbestos-related deaths per year: 1515 from mesothelioma, 58 asbestosis, 2830 lung cancer and 16 ovarian cancer. The ovarian cancer figure covered only the asbestos-cement and glassworks sectors. The authors noted uncertain exposure assessment and possible death-certificate errors. They also said ovarian cancer deaths were considerably underestimated, and that death data understate the burden of asbestosis, a low-fatality disease. They concluded that asbestos-related diseases remained a continuing burden in Italy despite the 1992 ban.

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: National burden-of-mortality estimate. It combined observed deaths from a national cause-of-death database with modelled attributable fractions drawn from Italian case-control studies and pooled occupational cohort studies.
• Who was studied: Deaths in the whole Italian population, 2010–2016, from the national mortality database (ISS, data from Istat). Lung and ovarian cancer estimates also drew on a pool of 43 Italian occupational cohorts (51,801 subjects) and on Italian population-based case-control studies.
• Exposure: Asbestos exposure in general; the article does not specify fiber types for its main estimates. The occupational estimates covered high-exposure sectors: asbestos-cement, rolling stock construction and maintenance, shipyards, dockyards and harbours, glassworks, insulation, asphalt roll production, industrial oven construction and mines.
• Main results:
  • Mesothelioma, Italy 2010–2016: 10,607 deaths (7660 men, 2947 women). Rates per 100,000 person-years were 3.84 (95% CI 3.76–3.93) in males and 1.11 (95% CI 1.07–1.15) in females.
  • The mesothelioma mortality trend over 2010–2016 increased among men and was stable among women.
  • Asbestosis, Italy 2010–2016: 405 deaths (361 men, 44 women).
  • Based on the pooled case-control studies, the attributable fraction of lung cancer deaths was 11% in men (range 7–12%) and 1% in women.
  • This corresponded to approximately 2718 asbestos-related lung cancer deaths per year in males and 112 in females.
  • In the high-exposure occupational sectors, about 302 asbestos-related lung cancer deaths per year were estimated (1814 over 2010–2015).
  • Ninety-six asbestos-related ovarian cancer deaths were estimated for 2010–2015, in the asbestos-cement and glassworks sectors only.
  • In total, about 4400 asbestos-related deaths per year were estimated for 2010–2016, approximately 3860 in men and 550 in women.
  • The yearly total comprised observed deaths from mesothelioma (1515) and asbestosis (58), plus estimated deaths from lung cancer (2830) and ovarian cancer (16).
  • The estimated asbestos-related lung cancer deaths were 8.4% of all lung cancer deaths in the period.
• The authors' conclusion: The authors concluded that, while acknowledging the limitations and uncertainty of the estimates, their study provides evidence of a continuing burden of asbestos-related diseases in Italy despite the 1992 asbestos ban.
• Limitations the authors state:
  • The case-control-based estimate may be affected by low accuracy in how exposure was defined.
  • The occupational-cohort method covered only selected economic sectors.
  • Leaving out sectors with many female workers, such as textiles, means asbestos-related ovarian cancer deaths were considerably underestimated.
  • Misclassification on death certificates could not be ruled out, so the authors advised prudence in interpreting the data.
  • Estimates based on mortality data understate the burden of disease from asbestosis, because it is a low-fatality disease.
  • The attributable fractions to asbestos must be evaluated with caution.

Topics

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

Medical terms in this study, explained in our Lexicon: Mesothelioma, Lung Cancer, Asbestos Exposure, Ovarian Cancer, Occupational Exposure.

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• Pleural mesothelioma mortality and asbestos exposure mapping in Italy — L. Fazzo, M. De Santis, et al. (2012)
• Cumulative asbestos exposure and mortality from asbestos related diseases in a pooled analysis of 21 asbestos cement cohorts in Italy — F. Luberto, D. Ferrante, et al. (2019)
• Epidemiological surveillance of mesothelioma mortality in Italy — L. Fazzo, G. Minelli, et al. (2018)
• Peritoneal mesothelioma mortality in Italy: Spatial analysis and search for asbestos exposure sources — A. Zona, L. Fazzo, et al. (2019)
• Asbestos-related lung cancer mortality in Piedmont, Italy — M. Martuzzi, P. Comba, et al. (1998)

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