Distribution and trends in mesothelioma mortality in Italy from 1974 to 2006

Our plain-English summary of Distribution and trends in mesothelioma mortality in Italy from 1974 to 2006, by M.P. Gatto, D. Tanna (International Archives of Occupational and Environmental Health, 2013).

The study

• Authors: M.P. Gatto, D. Tanna
• Journal: International Archives of Occupational and Environmental Health
• Published: 2013;86(4):489-96
• Cited by: 6 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Purpose: Using the epidemiological data of pleural cancer mortality, the authors estimated time trends and distribution of malignant mesothelioma in Italy during the period 1974-2006.

Methods: To describe temporal trends of the standardized mortality ratios (SMRs) in all the 20 Italian regions, we applied the Joinpoint Regression Model, developed by the National Cancer Institute (USA). The 107 provincial SMRs are represented on maps by using the Arcview GIS software (version 3.2).

Results: The high values from mesothelioma mortality in construction and shipbuilding sectors, previously reported, are confirmed by our analyses. Furthermore, data show that the annual percentage change is still growing: statistically significant increments in time trends are observed for 11 of 20 Italian regions. Of additional concern has been the identification of changes in 9 of 20 trends partially due to the misdiagnosis in the past.

Conclusions: Given the long latency of mesothelioma, preventive and legal measures with the ban of asbestos in Italy since 1992 are still not giving effects on mesothelioma mortality trends.

In plain English

This study examined pleural cancer deaths in Italy from 1974 to 2006, using national death certificates. The authors counted pleural cancer deaths as pleural mesothelioma, without tissue confirmation. In total, 20,417 male and 10,425 female cases were recorded. The highest values of what the authors call the SMR were in asbestos cement and shipbuilding areas. Provincial values for men were 7.04 in Alessandria, which contains Casale Monferrato, 8.59 in La Spezia and 8.19 in Genova. Female values in Liguria (1.40) and Piedmont (1.32) exceeded the national female value of 0.66; the authors suggested environmental exposure. Nationally, the annual percent change from 1981 to 2005 was 3.47 for men (95% confidence interval 3.1 to 3.9), 2.16 for women (1.4 to 2.9) and 2.94 overall (2.4 to 3.5), all statistically significant. Eleven of 20 regions showed a statistically significant short-term increase. In 9 regions, high late-1970s rates may partly reflect past misdiagnosis. The authors concluded that, despite Italy's 1992 ban, rates would probably keep rising for about ten more years.

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 mortality trends and geographic distribution based on death certificate data, using Joinpoint regression for time trends and maps of provincial values
• Who was studied: Deaths from pleural cancer recorded in Italy from 1974 to 2006, across 20 regions and 107 provinces: 20,417 male and 10,425 female cases
• Exposure: Individual exposure was not measured. Pleural cancer deaths (ICD-8 163.0, ICD-9 163, ICD-10 C38.4 and C45.0) were treated as pleural mesothelioma. The authors linked high-rate areas to asbestos cement industries, ports and shipbuilding. No fiber types are named.
• Main results:
  • Alessandria province, which contains the asbestos cement town of Casale Monferrato: SMR 7.04 for men and 3.43 for women
  • Port and shipbuilding provinces in Liguria: La Spezia, SMR 8.59 for men and 1.12 for women; Genova, 8.19 for men and 1.67 for women
  • Female SMRs were 1.40 in Liguria and 1.32 in Piedmont, compared with a national female SMR of 0.66. The authors suggested this could reflect environmental exposure.
  • Italy as a whole, 1981 to 2005: the annual percent change was 3.47 for men (95% CI 3.1 to 3.9), 2.16 for women (95% CI 1.4 to 2.9) and 2.94 for both sexes combined (95% CI 2.4 to 3.5). All were reported as statistically significant (p less than 0.05).
  • A statistically significant short-term increase was found in 11 of the 20 regions
  • In 9 of the 20 regions the trend changed between the 1970s and 1980s. The authors said the high rates of 1976 to 1979 might be partly due to past misdiagnosis.
• The authors' conclusion: The authors concluded that sites with asbestos cement industries and shipbuilding were the highest-risk areas. They also concluded that, despite the 1992 ban, the danger from asbestos exposure remains elevated, and that an increasing trend would probably continue for about another ten years.
• Limitations the authors state:
  • Pleural cancer deaths were used as an indirect estimate of pleural mesothelioma without histological confirmation. The authors noted that lung cancer and pleural cancer are known to be misclassified.
  • A coding change made late-1970s death counts about five times larger than early-1980s counts, distorting long-term trends
  • High risks in small local areas are diluted in national and regional figures
  • The authors' projections do not account for risk from asbestos as an environmental contaminant

Topics

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

Medical terms in this study, explained in our Lexicon: Mesothelioma, Malignant Mesothelioma, standardized mortality ratio (SMR), Misdiagnosis, Latency.

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