Mesothelioma Risk among Construction Workers According to Job Title: Data from the Italian Mesothelioma Register

Our plain-English summary of Mesothelioma Risk among Construction Workers According to Job Title: Data from the Italian Mesothelioma Register, by L. Vimercati, D. Cavone, L. De Maria, et al (La Medicina del Lavoro, 2023).

The study

• Authors: L. Vimercati, D. Cavone, L. De Maria, A. Caputi, F. Pentimone, S. Sponselli, G. Delvecchio, E. Chellini, A. Binazzi, D. Di Marzio, C. Mensi, D. Consonni, E. Migliore, D. Mirabelli, A. Angelini, A. Martini, C. Negro, F. D'Agostin, I. Grappasonni, C. Pascucci, L. Benfatto, D. Malacarne, V. Casotto, V. Comiati, C. Storchi, L. Mangone, S. Murano, L. Rossin, F. Tallarigo, F. Vitale, M. Verardo, S. Eccher, G. Madeo, T. Staniscia, F. Carrozza, I. Cozzi, E. Romeo, P. Pelullo, M. Labianca, M. Melis, G. Cascone, A. Marinaccio, G.M. Ferri, G. Serio
• Journal: La Medicina del Lavoro
• Published: 2023;114(3):e2023025
• Cited by: 4 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: An increased risk of mesothelioma has been reported in various countries for construction workers. The Italian National Mesothelioma Registry, from 1993 to 2018, reported exposure exclusively in the construction sector in 2310 cases. We describe the characteristics of these cases according to job title.

Methods: We converted into 18 groups the original jobs (N=338) as reported by ISTAT codes ('ATECO 91'). The exposure level was attributed at certain, probable and possible in accordance with the qualitative classification of exposure as reported in the Registry guidelines. Descriptive analysis by jobs highlights the total number of subjects for each single job and certain exposure, in descending order, insulator, plumbing, carpenter, mechanic, bricklayer, electrician, machine operator, plasterer, building contractor, painter and labourer.

Results: The cases grow for plumbing in the incidence periods 1993-2018, while, as expected, it decreases for insulator. Within each period considered the most numerous cases are always among bricklayers and labourers, these data confirm the prevalence of non-specialised "interchangeable" jobs in Italian construction sector in the past.

Conclusions: Despite the 1992 ban, the construction sector still presents an occupational health prevention challenge, circumstances of exposure to asbestos may still occur due to incomplete compliance with prevention and protection measures.

In plain English

This study described malignant mesothelioma cases in the Italian National Mesothelioma Registry (ReNaM) whose occupational asbestos exposure was only in construction. It covered 2,310 cases diagnosed from 1993 to 2018. Patients or their next of kin answered a standardized questionnaire, and exposure was graded as certain, probable or possible. No workplace fiber measurements were available, and the study did not report which asbestos fiber types the registry cases were exposed to. Overall, 64.8% of cases were classified as having certain exposure. Bricklayers made up 47% of cases, and plumbers and laborers 11% each. Mean latency from first exposure to diagnosis was 47.8 years, and mean age at diagnosis was 70.3 years. Exposure began between 1924 and 1960 in 52.8% of cases and between 1961 and 1991 in 46.3%. Insulator cases fell between the periods 2001 to 2010 and 2011 to 2018. Plumbing workers rose to second place after bricklayers in 2011 to 2018. The authors noted possible recall bias and uneven exposure assessment across regional registries. They concluded that much asbestos remains in older buildings and construction workers might still be at risk of 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: Descriptive analysis of cases from a national mesothelioma surveillance registry (case series grouped by job title); no comparison group or risk estimates
• Who was studied: 2,310 malignant mesothelioma cases in the Italian National Mesothelioma Registry (ReNaM), incidence period 1993-2018, whose occupational exposure was exclusively in the construction sector (ATECO 1991 code 45). Jobs were grouped from 338 original task codes into job groups. The article says 17 groups in the methods and 18 elsewhere.
• Exposure: Occupational asbestos exposure in construction jobs, assessed qualitatively from questionnaire interviews evaluated by industrial hygienists and graded certain (definite), probable or possible. Fiber types and workplace fiber measurements are not reported for the registry cases.
• Main results:
  • Of all 2,310 cases, 64.8% were classified as having certain exposure. Table 1 gives 1,497 certain, 208 probable and 605 possible.
  • By job, 47% of cases were bricklayers, and 11% each were plumbers and laborers. These were followed by carpenters and building contractors (6%), electricians (4.8%) and insulators (3.6%).
  • Ranked by the share of each job's cases with certain exposure, the order began with insulators, plumbers, carpenters, mechanics, bricklayers, electricians and machine operators.
  • Among all 2,310 cases, mean latency from start of exposure to diagnosis was 47.8 years (SD 11.8, range 11-82).
  • Among all 2,310 cases, mean age at diagnosis was 70.3 years (SD 9.9, range 29-97 years).
  • Exposure began between 1924 and 1960 in 52.8% of cases and between 1961 and 1991 in 46.3% of cases.
  • Insulator cases decreased between the incidence periods 2001-2010 and 2011-2018. Table 3 gives 46 and then 20 cases.
  • Among plumbing workers' cases, the share diagnosed per period rose from 41.1% in 2001-2010 to 50.5% in 2011-2018.
  • In the incidence period 2011-2018, plumbing workers made up 14.02% of cases. This put them in second place after bricklayers (47.3%) and ahead of laborers (10.6%).
• The authors' conclusion: The authors concluded that, although asbestos was banned in Italy in 1992, much asbestos remains in older buildings and construction workers might still be at risk of asbestos exposure and related occupational diseases.
• Limitations the authors state:
  • Exposure assessment was qualitative, and the ability to identify specific exposure circumstances was not entirely consistent among regional registries.
  • Recall bias cannot be excluded because exposure information was collected many years after the exposure. The authors state that the structured questionnaire minimized this.
  • Workplace measurements of asbestos fibers were not available in the registry.

Topics

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

Medical terms in this study, explained in our Lexicon: Mesothelioma, Insulator.

Related studies

• Mesothelioma Risk Among Maritime Workers According to Job Title: Data From the Italian Mesothelioma Register (ReNaM) — L. Vimercati, D. Cavone, et al. (2023)
• 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)
• Pleural mesothelioma risk in the construction industry: a case-control study in Italy, 2000-2018 — S. Stella, D. Consonni, et al. (2023)
• Incidence of extrapleural malignant mesothelioma and asbestos exposure, from the Italian national register — A. Marinaccio, A. Binazzi, et al. (2010)
• Malignant mesothelioma in construction workers: the Apulia regional mesothelioma register, Southern Italy — L. Vimercati, D. Cavone, et al. (2019)
• 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)

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