Pleural mesothelioma risk in the construction industry: a case-control study in Italy, 2000-2018

Our plain-English summary of Pleural mesothelioma risk in the construction industry: a case-control study in Italy, 2000-2018, by S. Stella, D. Consonni, E. Migliore, et al (BMJ Open, 2023).

The study

• Authors: S. Stella, D. Consonni, E. Migliore, A. Stura, D. Cavone, L. Vimercati, L. Miligi, S. Piro, M.T. Landi, N.E. Caporaso, S. Curti, S. Mattioli, G. Brandi, C. Gioscia, S. Eccher, S. Murano, V. Casotto, V. Comiati, C. Negro, F. D'Agostin, C. Genova, L. Benfatto, A. Romanelli, I. Grappasonni, G. Madeo, I. Cozzi, E. Romeo, S. Tommaso, F. Carrozza, M. Labianca, F. Tallarigo, G. Cascone, M. Melis, A. Marinaccio, A. Binazzi, C. Mensi, ReNaM Working Group members
• Journal: BMJ Open
• Published: 2023;13(8):e073480
• Cited by: 3 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Objectives: Workers in the construction industry have been exposed to asbestos in various occupations. In Italy, a National Mesothelioma Registry has been implemented more than 20 years ago. Using cases selected from this registry and exploiting existing control data sets, we estimated relative risks for pleural mesothelioma (PM) among construction workers.

Design: Case-control study.

Setting: Cases from the National Mesothelioma Registry (2000-2018), controls from three previous case-control studies.

Methods: We selected male PM incident cases diagnosed in 2000-2018. Population controls were taken from three studies performed in six Italian regions within two periods (2002-2004 and 2012-2016). Age-adjusted and period-adjusted unconditional logistic regression models were fitted to estimate odds ratios (OR) for occupations in the construction industry. We followed two approaches, one (primary) excluding and the other (secondary) including subjects employed in other non-construction blue collar occupations for >5 years. For both approaches, we performed an overall analysis including all cases and, given the incomplete temporal and geographic overlap of cases and controls, three time or/and space restricted sensitivity analyses.

Results: The whole data set included 15 592 cases and 2210 controls. With the primary approach (4797 cases and 1085 controls), OR was 3.64 (2181 cases) for subjects ever employed in construction. We found elevated risks for blue-collar occupations (1993 cases, OR 4.52), including bricklayers (988 cases, OR 7.05), general construction workers (320 cases, OR 4.66), plumbers and pipe fitters (305 cases, OR 9.13), painters (104 cases, OR 2.17) and several others. Sensitivity analyses yielded very similar findings. Using the secondary approach, we observed similar patterns, but ORs were remarkably lower.

Conclusions: We found markedly increased PM risks for most occupations in the construction industry. These findings are relevant for compensation of subjects affected with mesothelioma in the construction industry.

© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

In plain English

This case-control study examined pleural mesothelioma in men who worked in construction. The authors took 15 592 male cases diagnosed in 2000–2018 from Italy's National Mesothelioma Registry. They compared them with 2210 controls reused from three earlier studies in parts of six regions. The study compared occupations; the registry's asbestos-exposure assessments were not used. The main analysis left out men with more than 5 years in other blue-collar jobs (4797 cases, 1085 controls). In it, ever working in construction was linked to an odds ratio of 3.64 (90% confidence interval 3.17 to 4.19). Odds ratios were 7.05 (5.45 to 9.12) for bricklayers, 9.13 (5.58 to 14.9) for plumbers and pipe fitters, 4.66 (3.21 to 6.77) for general construction workers and 2.17 (1.41 to 3.36) for painters. For motor-vehicle drivers the odds ratio was 1.05 (0.39 to 2.81). Including all men gave similar patterns but lower odds ratios. The authors concluded that risk was clearly increased for most construction occupations. They noted that cases and controls overlapped only partly in time and place, and that occupation coding probably contained errors.

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: Case-control study (described by the authors as a 'control-initiated' case-control study) using registry cases and controls reused from three earlier case-control studies
• Who was studied: Men only. Cases were 15 592 men with pleural mesothelioma diagnosed in 2000–2018, from the Italian National Mesothelioma Registry (ReNaM), covering the whole country. Controls were 2210 men: 1617 from the EAGLE study (Lombardy, 2002–2004) and 593 from the MISEM/CARA studies (2012–2016; 490 MISEM, 103 CARA). The main (primary) analysis included 4797 cases and 1085 controls.
• Exposure: Ever employment in the construction industry and in specific construction-related occupations (for example bricklayers, plumbers and pipe fitters, painters, insulators, electrical wiremen), coded by international classifications. Asbestos exposure assessed at interview, and fiber types, were not used in the analysis.
• Main results:
  • Across the whole study period, 4729 (30.3%) of 15 592 cases and 402 (18.2%) of 2210 controls had ever been employed in construction.
  • Primary approach, overall analysis: men ever employed in construction had an odds ratio of 3.64 (90% CI 3.17 to 4.19; 2181 cases, 207 controls) compared with men never employed in construction.
  • Primary approach: blue-collar construction occupations as a group had an odds ratio of 4.52 (90% CI 3.87 to 5.29; 1993 cases, 151 controls).
  • Primary approach: bricklayers had an odds ratio of 7.05 (90% CI 5.45 to 9.12; 988 cases, 47 controls). Construction workers not elsewhere classified had an odds ratio of 4.66 (90% CI 3.21 to 6.77; 320 cases, 22 controls).
  • Primary approach: plumbers and pipe fitters had an odds ratio of 9.13 (90% CI 5.58 to 14.9; 305 cases, 12 controls). Construction painters had an odds ratio of 2.17 (90% CI 1.41 to 3.36; 104 cases, 18 controls).
  • Primary approach: motor-vehicle drivers had an odds ratio of 1.05 (90% CI 0.39 to 2.81; 14 cases, 4 controls). Odds ratios could not be calculated for several occupations, including plasterers, welders and flame-cutters, sheet-metal workers and crane and hoist operators.
  • Analyses restricted to cases from the same periods and/or areas as the controls largely confirmed the pattern of the overall analysis.
  • Pleural mesothelioma risk was also increased for men who worked in these occupations for less than 20 years.
  • Secondary approach (all men included, also those with more than 5 years in other blue-collar jobs): the pattern was similar, but odds ratios were lower.
• The authors' conclusion: The authors concluded that pleural mesothelioma risk was clearly increased for most occupations in the construction industry. They attributed this to past widespread asbestos use in the sector and said the results are relevant for compensation of affected construction workers.
• Limitations the authors state:
  • Cases came from the whole country and period, while controls came only from some areas and periods, so the overlap between cases and controls was only partial.
  • Different people collected the data in the various studies.
  • Errors and inconsistency in coding occupations are likely, partly because codes were translated with a crosswalk.
  • The large number of bricklayers among cases may partly reflect coding procedures.
  • The results may not apply fully to countries with different patterns of asbestos use.

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: Pleural Mesothelioma, Case-Control Study, Mesothelioma, Relative Risk, Odds Ratio.

Related studies

• Mesothelioma Risk among Construction Workers According to Job Title: Data from the Italian Mesothelioma Register — 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)
• Mesothelioma Risk Among Maritime Workers According to Job Title: Data From the Italian Mesothelioma Register (ReNaM) — L. Vimercati, D. Cavone, et al. (2023)
• Association between asbestos exposure and pericardial and tunica vaginalis testis malignant mesothelioma: a case-control study and epidemiological remarks — A. Marinaccio, D. Consonni, et al. (2020)
• Authors' response: Mezei et al's "Comments on a recent case-control study of malignant mesothelioma of the pericardium and the tunica vaginalis testis" — A. Marinaccio, D. Consonni, et al. (2021)
• Lung cancer risk among workers in the construction industry: results from two case-control studies in Montreal — A. Lacourt, J. Pintos, et al. (2015)

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