Recognized Occupational Diseases in Italy's Friuli-Venezia Giulia and Liguria Regions (2010-2021)

Our plain-English summary of Recognized Occupational Diseases in Italy's Friuli-Venezia Giulia and Liguria Regions (2010-2021), by F. Larese Filon, J. Granzotto, A. Bignotto, et al (La Medicina del Lavoro, 2023).

The study

• Authors: F. Larese Filon, J. Granzotto, A. Bignotto, B. Alessandrini, P. Barbina, F. Rui
• Journal: La Medicina del Lavoro
• Published: 2023;114(5):e2023044
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: The study of recognized occupational diseases trend is important to understand the preventive approach needed in the future, however, while numbers of occupational diseases are available on web, data on incidence are missing. The aim of our study was to analyze the trend and the incidence rate ratio (IRR) of recognized occupational diseases in Italy, in Friuli-Venezia Giulia region (FVG) and Liguria region from 2010 to 2021.

Methods: Numbers of recognized occupational diseases by the Italian National Insurance for Occupational Diseases (INAIL) were analyzed and incidence were calculated considered the total number of workforces in the area. A Poisson regression model was used to estimate incidence trends.

Results: FVG region presented a higher incidence of all occupational diseases compared to Italy and to Liguria in the period considered. The overall incidence in 2019 was 175, 91.8 and 108 cases for 100,000 workers, for FVG, Liguria and Italy respectively. Musculoskeletal disorders (MSDs) were the majority of occupational diseases with 100, 51 and 82.8 cases per 100,000 workers, in FVG, Liguria and Italy, respectively. Incidence of occupational cancers was 16, 10 and 4.9 cases per 100,000 workers, in FVG, Liguria and Italy, respectively. The annual change of incidence from 2010 to 2019 was positive for MSDs (IRR 1.06; 95%CI 1.06 to 1.07) and decreasing for the other causes in Italy. In FVG region the trend was positive for MSDs (IRR 1.05;95%CI 1.04 to 1.06), for respiratory diseases (IRR 1.03; 95%CI 1.00 to 1.05) and pleural plaques (IRR 1.03; 95%CI 1.00 to 1.06). In Liguria the trend was positive for MSDs (IRR 1.17; 95% CI 1.15-1.19) and for pleural plaques (IRR 1.07; 95%CI 1.03-1.12). Stable trends were found for cancers. Declining trend was shown for noise induced hearing loss and skin diseases.

Conclusions: FVG region presented a higher incidence of recognized occupational diseases compared to Liguria region and Italian data. Results that can be explained by a higher propensity of claiming for occupational diseases in workers, mainly for MSDs disorders. For cancers and asbestos-related diseases the higher incidence can be attributable to high exposure to asbestos in FVG and Liguria workers mainly in shipyard and dock activities.

In plain English

This study used records of occupational diseases recognized by Italy's national workers' insurer (INAIL) to compare Friuli-Venezia Giulia (FVG) and Liguria with all of Italy, 2010 to 2021. The authors chose the two regions partly because both had high past asbestos exposure in shipyards and docks. Rates were calculated per 100,000 workers, and trends were estimated for 2010 to 2019. In 2019 the overall rate was 175 in FVG, 91.8 in Liguria and 108 in Italy. Musculoskeletal disorders were the largest group. Over the 12 years, recognized pleural plaques reached 189.8 per 100,000 workers in FVG, 41.9 in Liguria and 16.2 in Italy. Fitted 2010 to 2019 trends for pleural plaques were upward in FVG (IRR 1.03, 95% CI 1.00 to 1.06) and Liguria (1.07, 1.03 to 1.12) and downward in Italy (0.98, 0.97 to 0.99). FVG's yearly rate was nonetheless lower in 2019 than in 2010. Asbestosis declined in all three areas, with Liguria's rates the highest. Mesothelioma trends were not statistically significant in the article's table. The authors attributed the regions' higher asbestos-related disease rates to past exposure, mainly in shipyards and docks. They noted that rates could not be adjusted for age.

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: Analysis of national insurance records of recognized occupational diseases, with yearly trends estimated by Poisson regression (register-based trend study)
• Who was studied: Occupational diseases recognized by INAIL in Italy as a whole and in the Friuli-Venezia Giulia and Liguria regions, 2010 to 2021, with incidence calculated against the regional and national workforce
• Exposure: No exposure was measured. The two regions were chosen partly because of high past asbestos exposure in the shipyard and dock sectors. No fiber types are named. Diseases were grouped by ICD-10 codes, including cancers, mesothelioma (C45), asbestosis (J61) and pleural plaques (J92).
• Main results:
  • Overall incidence of recognized occupational diseases in 2019 was 175 per 100,000 workers in FVG, 91.8 in Liguria and 108 in Italy.
  • Musculoskeletal disorders were the majority of recognized occupational diseases: 100 per 100,000 workers in FVG, 51 in Liguria and 82.8 in Italy.
  • Over 12 years, pleural plaque incidence was 189.8 per 100,000 workers in FVG, 41.9 in Liguria and 16.2 in Italy.
  • The fitted 2010 to 2019 trend in pleural plaque incidence was upward in FVG (1.03, 95% CI 1.00 to 1.06) and in Liguria (1.07, 95% CI 1.03 to 1.12). The authors label these figures 'OR' here, but the table presents them as annual incidence rate ratios.
  • FVG's yearly pleural plaque rate did not rise in every year. It was 19.1 per 100,000 workers in 2010, 22.1 in 2015 and 17.9 in 2019, then fell to 10.1 in 2021.
  • In Italy as a whole, the fitted pleural plaque trend over 2010 to 2019 declined significantly (0.98, 95% CI 0.97 to 0.99).
  • In 2019, compared with Italian data, FVG workers had 8.6 times the incidence of recognized pleural plaques, 4.1 times that of lung diseases, 3.2 times that of cancers and 2.7 times that of mesothelioma.
  • In 2019, cancers (including mesothelioma) in FVG were 16 cases per 100,000 workers.
  • Asbestosis trends from 2010 to 2019 (annual incidence rate ratio) declined in FVG (0.90, 95% CI 0.83 to 0.99; 61 cases), Liguria (0.90, 95% CI 0.87 to 0.93; 531 cases) and Italy (0.96, 95% CI 0.95 to 0.96; 3,129 cases).
  • Liguria had much higher asbestosis numbers: 13.1 per 100,000 workers in 2010 (83 cases), declining to 5.5 per 100,000 in 2019 (30 cases).
  • The authors also calculated 2019 asbestosis incidence using the number of shipyard-sector workers as the denominator: 6/4297 (139 per 100,000) in FVG and 30/4985 (601 per 100,000) in Liguria.
  • Mesothelioma trends from 2010 to 2019 (annual incidence rate ratio) were 0.97 (95% CI 0.94 to 1.002; 427 cases) in FVG, 0.99 (95% CI 0.96 to 1.02; 529 cases) in Liguria and 0.997 (95% CI 0.99 to 1.01; 6,040 cases) in Italy. All three intervals include 1, meaning no statistically significant change.
• The authors' conclusion: The authors concluded that the higher overall incidence, mainly of musculoskeletal disorders, may be explained by a greater propensity to claim. They attributed the higher incidence of cancers and asbestos-related diseases to high asbestos exposure of FVG and Liguria workers, mainly in shipyard and dock activities.
• Limitations the authors state:
  • The available data did not allow incidence to be standardized by age group.
  • Reporting and recognition of occupational diseases differ between Italian regions.
  • Data for the last two years (2020 to 2021) were not considered stable, so they were excluded from the trend analysis, and some cases may still be missing.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Pleural plaques and thickening.

Medical terms in this study, explained in our Lexicon: Occupational Disease, Incidence, Pleural Plaques.

Related studies

• Pleural and peritoneal mesotheliomas in the Friuli Venezia Giulia register: data analysis from 1995 to 2015 in Northeastern Italy — F. D'Agostin, P. De Michieli, et al. (2017)
• Trends in Occupational Diseases in Italian Industry and Services From 2006 To 2019 — F. Larese Filon, O. Spadola, et al. (2023)
• Incidence of pleural mesothelioma in Liguria Region, Italy (1996-2002) — V. Gennaro, D. Ugolini, et al. (2005)
• Occupational diseases in Poland--an overview of current trends — N. Szeszenia-Dąbrowska, U. Wilczyńska (2013)
• Trends in suspected and recognized occupational respiratory diseases in Germany between 1970 and 2005 — V. van Kampen, R. Merget, et al. (2008)
• Occupational cancer in Italy — E. Merler, P. Vineis, et al. (1999)

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