Industrial pollution and pleural cancer mortality in Spain

Our plain-English summary of Industrial pollution and pleural cancer mortality in Spain, by G. López-Abente, P. Fernández-Navarro, E. Boldo, et al (The Science of the Total Environment, 2012).

The study

• Authors: G. López-Abente, P. Fernández-Navarro, E. Boldo, R. Ramis, J. García-Pérez
• Journal: The Science of the Total Environment
• Published: 2012;424:57-62
• Cited by: 16 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Pleural cancer mortality is an acknowledged indicator of exposure to asbestos and mesothelioma mortality but in 15%-20% of cases no exposure can be recalled. In the past, asbestos was used in many industries and it is still found in many installations. Our objective was to ascertain whether there might be excess pleural cancer mortality among populations residing in the vicinity of Spanish industrial installations that are governed by the Integrated Pollution Prevention and Control (IPPC) Directive and the European Pollutant Release and Transfer Register Regulation and report their emissions to air. An ecological study was designed to examine pleural cancer mortality at a municipal level (8098 Spanish towns) over the period 1997-2006, during which 2146 deaths were registered. We conducted an exploratory "near vs. far" analysis to estimate the relative risks (RRs) of towns situated at a distance of <2 km from installations. This analysis was repeated for each of the 24 industrial groups. RR and their 95% credible intervals (95% CIs) were estimated on the basis of a Poisson conditional autoregressive Bayesian model with explanatory variables. Integrated nested Laplace approximations were used as a Bayesian inference tool. Analysis showed statistically significant RRs in both sexes in the vicinity of 7 of the 24 industrial groups studied (RR, 95% CI), namely, biocide facilities (2.595, 1.459-4.621), ship-building (2.321, 1.379-3.918), glass and mineral fibre production (1.667, 1.041-2.665), non-hazardous waste treatment (1.737, 1.077-2.799), galvanising (1.637, 1.139-2.347), organic chemical plants (1.386, 1.075-1.782) and the food and beverage sector (1.255, 1.006-1.562). In the proximity of sources pertaining to the biocide, organic chemical and galvanising sectors, the risk was seen to be rising among men and women, a finding that could indicate airborne environmental exposure. These results support that residing in the vicinity of IPPC-registered industries that release pollutants to the air constitutes a risk factor for pleural cancer.

Copyright © 2012 Elsevier B.V. All rights reserved.

In plain English

This ecological study examined pleural cancer deaths in 8,098 Spanish towns from 1997 to 2006, when 2146 deaths were registered. It compared towns whose centre lay within 2 km of registered industrial plants reporting releases to air in 2007 with towns having no such plant nearby. This was done separately for 24 industry groups. Asbestos itself was not measured. Overall, towns near these plants had around 20% higher risk. For both sexes combined, statistically significant relative risks were found near seven groups, ranging from 2.595 (95% credible interval 1.459 to 4.621) near biocide plants and 2.321 (1.379 to 3.918) near ship building down to 1.255 (1.006 to 1.562) near the food and beverage sector. Among women, raised risks were reported near refineries, biocide and organic chemical plants. The authors concluded that living near these industries was associated with pleural cancer mortality. They suggested that associations seen in men rather than women may reflect work exposure, while risks rising in both sexes near some sectors could indicate airborne exposure. They could not account for when the plants began operating.

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: Ecological study comparing pleural cancer mortality in towns near versus far from industrial installations, using Bayesian spatial (BYM) and mixed Poisson regression models
• Who was studied: Residents of 8,098 Spanish towns (municipalities), 1997 to 2006, with 2146 pleural cancer deaths. Deaths were coded ICD-9 163 and ICD-10 C38.4 and C45.0 (malignant pleural neoplasm), not mesothelioma alone.
• Exposure: Residence in a town whose centroid lay 2 km or less from an IPPC-registered industrial installation reporting releases to air in 2007, analysed for 24 industrial groups. Asbestos exposure was not measured directly.
• Main results:
  • Across the sexes, populations living 2 km or less from the pollutant facilities had around 20% higher risk than unexposed or distant populations (both models).
  • Both sexes, BYM model, statistically significant relative risks (95% credible intervals):
• biocide facilities 2.595 (1.459 to 4.621)
• ship building 2.321 (1.379 to 3.918)
• non-hazardous waste treatment 1.737 (1.077 to 2.799)
• glass and mineral fibre production 1.667 (1.041 to 2.665)
• galvanising 1.637 (1.139 to 2.347)
• organic chemical plants 1.386 (1.075 to 1.782)
• food and beverage sector 1.255 (1.006 to 1.562)
  • Men, BYM model, statistically significant excess mortality:
• ship building 2.921 (1.606 to 5.334)
• biocide facilities 2.884 (1.465 to 5.690)
• non-hazardous waste treatment 2.184 (1.281 to 3.723)
• galvanising 1.778 (1.157 to 2.724)
• glass and mineral fibre production 1.774 (1.031 to 3.046)
• combustion installations 1.512 (1.011 to 2.259)
• organic chemical plants 1.431 (1.067 to 1.916)
• food and beverage sector 1.396 (1.081 to 1.799)
• surface treatment of metals and plastics 1.313 (1.040 to 1.659)
  • Women: excess mortality was reported near refineries, 2.828 (1.107 to 7.252), and near biocide facilities, 3.176 (1.253 to 8.045).
  • Women: excess mortality was reported near organic chemical plants, 1.788 (1.234 to 2.597). Galvanising was listed with these as significant at 1.750, but its printed interval (0.972 to 3.150) includes 1.
• The authors' conclusion: The authors concluded that living near IPPC-registered industries with emissions to air is associated with pleural cancer mortality. They thought associations found in men rather than women may reflect occupational exposures. They thought risk rising in both men and women near biocide, organic chemical and galvanising sources could indicate airborne environmental exposure. They suggested that many industries may have used asbestos.
• Limitations the authors state:
  • Induction periods were not taken into account because the year industrial operations began was unknown.
  • The authors did not know exactly how accurate pleural cancer death certificates were.
  • Two disease classifications were used. ICD-9 has only a general pleural cancer rubric, and ICD-10 code C38.4 indicates cancer in the pleura regardless of tumour type.
  • Some relative risk estimates changed direction, or the association disappeared, depending on the model used.

Topics

Medical terms in this study, explained in our Lexicon: Mesothelioma, Relative Risk, Environmental Exposure.

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