Estimation of Occupational Exposure to Asbestos in Italy by the Linkage of Mesothelioma Registry (ReNaM) and National Insurance Archives. Methodology and Results

Our plain-English summary of Estimation of Occupational Exposure to Asbestos in Italy by the Linkage of Mesothelioma Registry (ReNaM) and National Insurance Archives. Methodology and Results, by C. Airoldi, D. Ferrante, L. Miligi, et al (International Journal of Environmental Research and Public Health, 2020).

The study

• Authors: C. Airoldi, D. Ferrante, L. Miligi, S. Piro, G. Stoppa, E. Migliore, E. Chellini, A. Romanelli, C. Sciacchitano, C. Mensi, D. Cavone, E. Romeo, S. Massari, A. Marinaccio, C. Magnani
• Journal: International Journal of Environmental Research and Public Health
• Published: 2020;17(3)
• Cited by: 5 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

The identification and monitoring of occupational cancer is an important aspect of occupational health protection. The Italian law on the protection of workers (D. Leg. 81/2008) includes different cancer monitoring systems for high and low etiologic fraction tumors. Record linkage between cancer registries and administrative data is a convenient procedure for occupational cancer monitoring. We aim to: (i) Create a list of industries with asbestos exposure and (ii) identify cancer cases who worked in these industries. The Italian National Mesothelioma Registry (ReNaM) includes information on occupational asbestos exposure of malignant mesothelioma (MM) cases. We developed using data from seven Italian regions a methodology for listing the industries with potential exposure to asbestos linking ReNaM to Italian National Social Security Institute (INPS) data. The methodology is iterative and adjusts for imprecision and inaccuracy in reporting firm names at interview. The list of asbestos exposing firms was applied to the list of cancer cases (all types associated or possibly associated with asbestos according to International Agency for Research on Cancer (IARC) monograph 100C) in two Italian regions for the indication of possible asbestos exposure. Eighteen percent of the cancer cases showed at least one work period in firms potentially exposing to asbestos, 48% of which in regions different from where the cases lived at diagnosis. The methodology offers support for the preliminary screening of asbestos exposing firms in the occupational history of cancer cases.

In plain English

This was a methodological study from Italy that linked records between databases. The authors took 6057 malignant mesothelioma cases diagnosed in 1993–2012 in seven regions and recorded in the National Mesothelioma Registry (ReNaM) with evidence of occupational asbestos exposure. They linked these cases to national pension records (INPS), and 4134 (68.25%) were linked. By matching firm names, 5327 of 12,801 job records (41.61%) were matched. This gave a list of 2606 firms rated as having certain (1826), probable (222) or possible (558) asbestos exposure. The list was applied to 35,010 cases of cancers that IARC links or possibly links to asbestos, from Lazio and Sicily. In all, 5092 Lazio cases and 1454 Sicily cases had worked in a listed firm. Excluding pleural cancers, the authors reported this as 18.5% (6400) of cases. About half of matched records relied on firms listed by other regions. The authors noted that the pension records omit agriculture, public employment, armed forces and self-employed workers. They called the method only a screening tool needing expert validation, and concluded that such linkage is a valuable tool for identifying asbestos exposure.

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: Methodological record-linkage study: linking a mesothelioma registry to national pension-contribution records to build a list of possibly asbestos-exposing firms, then applying that list to other cancer cases
• Who was studied: 6057 malignant mesothelioma cases diagnosed 1993–2012 in seven Italian regions (Piedmont, Lombardy, Tuscany, Emilia-Romagna, Lazio, Apulia, Sicily). The firm list was then applied to 35,010 cancer cases: 25,162 from Lazio hospital discharges (2008–2015) and 9848 from the Eastern Sicily cancer registry (2011–2014)
• Exposure: Occupational asbestos exposure in firms, as rated by ReNaM experts from interviews (certain, probable, possible). No fiber types are specified. For the other cancer cases, exposure was indicated only by having worked in a listed firm
• Main results:
  • Of 6057 mesothelioma cases included, 4134 (68.25%) were linked to the INPS pension database
  • Of 12,801 ReNaM job records, 5327 (41.61%) were matched to official firm names, with large variation between regions
  • The resulting 'dictionary' contained 2606 unique firms: 1826 (70.07%) rated certain, 222 (8.52%) probable and 558 (21.41%) possible asbestos exposure
  • Among the 35,010 cancer cases, 1454 Sicily cases and 5092 Lazio cases had worked in a firm on the list
  • Excluding pleural malignancies, the authors reported that 18.5% (6400) of the cancer cases could be related to occupational asbestos exposure, meaning they had worked in a listed firm
  • About half of matched records were identified using firm information from other regions: 1608 (51.59%) for Sicily and 3463 (46.56%) for Lazio
• The authors' conclusion: The authors concluded that record linkage between mesothelioma registries and administrative databases is a valuable tool for identifying asbestos exposure, and that it gives an indicator applicable to surveillance of all cancer types of interest for asbestos exposure
• Limitations the authors state:
  • The INPS database excludes agriculture, public employment, armed forces and self-employed workers, and covers only contributions from 1974 onwards
  • The quality of the linkage is difficult to determine
  • Missed links mean some exposing firms are left off the list (false negatives), and some listed firms may have had no exposure (false positives)
  • Very large firms with different plants are not recognized separately by the linkage
  • The procedure is only a screening tool, and its results must be validated by local experts reviewing each case's actual work history

Topics

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

Medical terms in this study, explained in our Lexicon: Occupational Exposure, Mesothelioma, Population Attributable Fraction (PAF), Asbestos Exposure, Malignant Mesothelioma, IARC, Occupational History.

Related studies

• Asbestos Exposure and Malignant Mesothelioma in Construction Workers-Epidemiological Remarks by the Italian National Mesothelioma Registry (ReNaM) — A. Binazzi, D. Di Marzio, et al. (2021)
• Non-occupational exposure to asbestos and malignant mesothelioma in the Italian National Registry of Mesotheliomas — D. Mirabelli, D. Cavone, et al. (2010)
• 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)
• 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)
• Mesothelioma Risk Among Maritime Workers According to Job Title: Data From the Italian Mesothelioma Register (ReNaM) — L. Vimercati, D. Cavone, et al. (2023)

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