Mortality rates from asbestos-related diseases in Italy during the first year of the COVID-19 pandemic

Our plain-English summary of Mortality rates from asbestos-related diseases in Italy during the first year of the COVID-19 pandemic, by L. Fazzo, E. Grande, A. Zona, et al (Frontiers in Public Health, 2023).

The study

• Authors: L. Fazzo, E. Grande, A. Zona, G. Minelli, R. Crialesi, I. Iavarone, F. Grippo
• Journal: Frontiers in Public Health
• Published: 2023;11:1243261
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background And Aim: Patients with interstitial lung diseases, including asbestosis, showed high susceptibility to the SARS-CoV-2 virus and a high risk of severe COVID-19 symptoms. Italy, highly impacted by asbestos-related diseases, in 2020 was among the European countries with the highest number of COVID-19 cases. The mortality related to malignant mesotheliomas and asbestosis in 2020 and its relationship with COVID-19 in Italy are investigated.

Methods: All death certificates involving malignant mesotheliomas or asbestosis in 2010-2020 and those involving COVID-19 in 2020 were retrieved from the National Registry of Causes of Death. Annual mortality rates and rate ratios (RRs) of 2020 and 2010-2014 compared to 2015-2019 were calculated. The association between malignant pleural mesothelioma (MPM) and asbestosis with COVID-19 in deceased adults ≥80 years old was evaluated through a logistic regression analysis (odds ratios: ORs), using MPM and asbestosis deaths COVID-19-free as the reference group. The hospitalization for asbestosis in 2010-2020, based on National Hospital Discharge Database, was analyzed.

Results: In 2020, 746,343 people died; out of them, 1,348 involved MPM and 286 involved asbestosis. Compared to the period 2015-2019, the mortality involving the two diseases decreased in age groups below 80 years; meanwhile, an increasing trend was observed in subjects aged 80 years and older, with a relative mortality risks of 1.10 for MPM and 1.17 for asbestosis. In subjects aged ≥80 years, deaths with COVID-19 were less likely to have MPM in both genders (men: OR = 0.22; women: OR = 0.44), while no departure was observed for asbestosis. A decrease in hospitalization in 2020 with respect to those in 2010-2019 in all age groups, both considering asbestosis as the primary or secondary diagnosis, was observed.

Conclusions: The increasing mortality involving asbestosis and, even if of slight entity, MPM, observed in people aged over 80 years during the 1st year of the COVID-19 pandemic, aligned in part with the previous temporal trend, could be due to several factors. Although no positive association with COVID-19 mortality was observed, the decrease in hospitalizations for asbestosis among individuals aged over 80 years, coupled with the increase in deaths, highlights the importance of enhancing home-based assistance during the pandemic periods for vulnerable patients with asbestos-related conditions.

Copyright © 2024 Fazzo, Grande, Zona, Minelli, Crialesi, Iavarone and Grippo.

In plain English

This cross-sectional study used Italy's national death-certificate registry to examine deaths involving malignant mesothelioma, especially malignant pleural mesothelioma (MPM), and asbestosis in 2010–2020, plus hospital stays with asbestosis. Of 746,324 deaths in Italy in 2020, 1,348 mentioned MPM and 286 mentioned asbestosis anywhere on the certificate. Compared with 2015–2019, mortality in the whole population in 2020 was similar for both diseases. Among people aged 80 and over it was higher: the rate ratio was 1.10 (90% confidence interval 1.02–1.19) for MPM and 1.17 (1.02–1.34) for asbestosis. Among deaths at age 80 and over, those mentioning COVID-19 were less likely to mention MPM (odds ratio 0.22, 90% CI 0.14–0.35, in men; 0.44, 0.25–0.77, in women). For asbestosis there was no clear difference. Hospitalizations with asbestosis fell in 2020. The authors concluded that these diseases did not appear to be direct risk factors for COVID-19 death. They said the rise partly followed a trend seen since 2010, and that reduced health care during the pandemic could be an indirect cause. They noted that causes of death may have been under-reported.

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: Cross-sectional study of national death-certificate data, with logistic regression and an analysis of hospital discharge data
• Who was studied: All deaths in Italy involving asbestosis, malignant mesothelioma (MM) or COVID-19 from 2010 to 2020, from the National Register of Causes of Death, plus all Italian hospitalizations related to asbestosis in the same period; the COVID-19 comparison was limited to deaths at age 80 and over in 2020
• Exposure: No asbestos exposure, fiber type or job data were analyzed. The comparisons were deaths in 2020 (first pandemic year) against 2015–2019 (and 2010–2014), and, among deaths at age 80 and over, deaths with versus without COVID-19 on the certificate
• Main results:
  • In Italy in 2020, 746,324 people died. Counting only the underlying cause, 74 died from asbestosis, 1,552 from MM (including 1,249 from MPM) and 78,673 from COVID-19
  • Counting any mention on the death certificate in 2020, 286 deaths involved asbestosis and 1,695 involved MM, including 1,348 involving MPM
  • In 2020 the number of deaths involving asbestosis was 13% higher than the 2015–2019 yearly average. Deaths involving MPM decreased slightly (1,348 in 2020 vs a yearly average of 1,373 in 2015–2019)
  • Compared with 2015–2019, 2020 mortality in the overall population was similar for both diseases
  • In people aged 80 and over, 2020 mortality was higher than in 2015–2019: for MPM the rate ratio was 1.10 (90% CI 1.02–1.19), and for asbestosis it was 1.17 (90% CI 1.02–1.34)
  • Among 2020 deaths at age 80 and over, deaths involving COVID-19 were less likely to mention MPM. In men the OR was 0.22 (90% CI 0.14–0.35; 14 MPM deaths with COVID-19 vs 371 without). In women it was 0.44 (90% CI 0.25–0.77; 9 vs 158). For asbestosis there was no departure: the OR was 0.96 (0.66–1.39) in men and 0.79 (0.14–4.45) in women
  • Hospitalizations with asbestosis decreased in 2020 compared with 2015–2019 and 2010–2014, whether asbestosis was the primary or a secondary diagnosis
• The authors' conclusion: The authors concluded that MPM and asbestosis did not seem to have been direct risk factors for COVID-19 mortality. They said the 2020 increase in people aged 80 and over could partly reflect the trend seen since 2010, and that reduced healthcare and hospitalization during the pandemic could be an indirect cause. They called for more home-based assistance for these patients during pandemic periods
• Limitations the authors state:
  • Other causes of death may have been under-reported in favor of COVID-19 during the pandemic
  • COVID-19 itself may have been under-reported in the first months of the pandemic, so the association with COVID-19 may have been underestimated
  • Under-reporting or lack of specificity of causes stated on death certificates cannot be completely excluded

Topics

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

Medical terms in this study, explained in our Lexicon: Interstitial Lung Disease, Malignant Mesothelioma, Death Certificate, rate ratio, Pleural Mesothelioma, Odds Ratio.

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