Marina Mastrantonio

Predictions of mortality from pleural mesothelioma in Italy: A model based on asbestos consumption figures supports results from age-period-cohort models

Italy was the second main asbestos producer in Europe, after the Soviet Union, until the end of the 1980s, and raw asbestos was imported on a large scale until 1992. The Italian pattern of asbestos consumption lags on average about 10 years behind the United States, Australia, the United Kingdom and the Nordic countries. Measures to reduce exposure were introduced in the mid‐1970s in some workplaces. In 1986, limitations were imposed on the use of crocidolite and in 1992 asbestos was definitively banned. We have used primary pleural cancer mortality figures (1970–1999) to predict mortality from mesothelioma among Italian men in the next 30 years by age‐cohort‐period models and by a model based on asbestos consumption figures. The pleural cancer/mesothelioma ratio and mesothelioma misdiagnosis in the past were taken into account in the analysis. Estimated risks of birth cohorts born after 1945 decrease less quickly in Italy than in other Western countries. The findings predict a peak with about 800 mesothelioma annual deaths in the period 2012–2024. Results estimated using age‐period‐cohort models were similar to those obtained from the asbestos consumption model.

Retrospective mortality cohort study of Italian workers compensated for silicosis.

Objectives: To estimate cause specific mortality in a large cohort of Italian workers compensated for silicosis. Methods: The cohort included 14 929 subjects (14 098 men and 831 women) compensated for silicosis between 1946 and 1979, alive on 1 January 1980, and resident in Tuscany (a region of central Italy with 3 547 000 inhabitants). Mortality follow up ranged from 1980 to 1999. Vital status and the causes of death were determined by linkage with the regional mortality registry and with the national mortality database. The cohort mortality rates were compared to the rates of the local reference population. SMRs and their 95% confidence intervals were computed assuming a Poisson distribution of the observed deaths. Specific SMR analyses were performed according to the level of disability, the year of compensation assignment, and the job type. Results: A significant excess mortality was observed in male silicotics for cancer of the lung, trachea, and bronchus and cancer of the liver, respiratory diseases (silicosis, asbestosis, antracosilicosis, and other pneumoconiosis), and for tubercolosis. Statistically significant mortality excess was observed in female silicotics for respiratory diseases (specifically silicosis and other pneumoconiosis) and tuberculosis. Analyses for period of compensation assignment showed a twofold increased SMR for biliary tract cancer among female workers and for liver cancer among male workers compensated before 1970. Conclusions: The excess mortality from respiratory tract cancers and respiratory tract diseases detected in Italian compensated silicotics are in agreement with previous epidemiological studies. Although the twofold increased risk for liver cancer among males is suggestive of a possible association with silica dust exposure, the finding needs to be confirmed.

Female lung cancer mortality and long-term exposure to particulate matter in Italy

Background: Outdoor air pollution and particulate matter (PM) have recently been classified in Group 1 by IARC. In Italy there is no epidemiological study on the association between female lung cancer and PM as measured by the official monitoring stations. Methods: We estimated the dose–response relationship between female lung cancer mortality and available long-term outdoor PM10 and/or PM2.5 concentrations for all the Italian province capital city municipalities (respectively, 64 and 32 municipalities). Multiple regression analysis of standardized mortality rates (SMRates) for the period 2000–11, as a function of PM concentrations, considering percentage of smokers and deprivation index as additional explanatory variables, was performed for PM10 only. Results: The number of province capital cities with available PM2.5 data was not sufficient to detect a significant increment of SMRates as a function of concentrations. An SMRate increase of 0.325 for 1 &mgr;g m−3 increment of PM10 concentration was calculated. Moreover, the attributable risk of the overall SMRates for the two subgroups of municipalities under/equal and above 20 &mgr;g m−3 value was evaluated. Attributable deaths were computed by both the unitary SMRate increase and the attributable risk. A rough estimate of the impact of PM10 exposure at level above the WHO guideline value of 20 &mgr;g m−3 in these 64 municipalities is between 2920 and 3449 lung cancer deaths out of 22 162 (13–16%). Conclusion: Maintaining the PM10 concentrations below such WHO recommendation, an overall saving of nearly 300 lung cancer deaths per year in a population of 8 146 520 women living in the municipalities at study has been evaluated.

Drinking water contamination from perfluoroalkyl substances (PFAS): an ecological mortality study in the Veneto Region, Italy

Background Perfluoroalkyl substances (PFAS), a heterogeneous group of highly stable man-made chemicals, have been widely used since 1960s and can be detected almost ubiquitously in all environmental matrices. In Italy, on January 2014, drinking water contamination in an area of the Veneto Region was detected mainly due to the drain of fluorinated chemicals by a manufacturing company operating since 1964. Methods The present ecological mortality study was aimed at comparing mortality for some causes of death selected on the basis of previous reported associations, during the period 1980-2013, in municipalities with PFAS contaminated and uncontaminated drinking water on the basis of the levels indicated by the Italian National Health Institute (ISS). Sex-specific number, standardized mortality rates and rate ratios (RR) for PFAS contaminated and uncontaminated areas were computed for each cause of death through the ENEA epidemiological database. Results In both sexes, statistically significant RRs were detected for all causes mortality, diabetes, cerebrovascular diseases, myocardial infarction and Alzheimers disease. In females, RRs significantly higher than 1.0 were also observed for kidney and breast cancer, and Parkinsons disease. Increased risk, although not statistically significant, was observed for bladder cancer in both sexes, and for testicular cancer, pancreatic cancer and leukemia in males only. Conclusions Higher mortality levels for some causes of death, possibly associated with PFAS exposure, were detected in contaminated municipalities in comparison with uncontaminated ones with similar socioeconomic status and smoking habits. These results warrant further individual level analytic studies to delineate casual associations.