An analysis of death certificates from 1987 to 1996 among residents of the Tuscany Region identified 1518 deaths from pneumoconiosis, the large majority from silicosis, a disease explained by occupational exposure to silica dust. A dozen of deaths are from asbestosis, occurred at younger ages and are concentrated in a restricted area where a cement-asbestos factory was active. Deaths from pneumoconiosis occurred mainly among males, and the rates of the disease are decreasing only in the latest years. About 10% of deaths from silicosis are among subjects dying before 65 years of age. Mortality rates are very high in several areas of the Region, approximating those from lung cancer and ischaemic heart disease. For the above reasons the disease is still of concern from the point of view of public health and actions are suggested to obtain a description of prevalence and incidence of the disease.

Cause of Death↗

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[Inequalities in mortality in the Italian longitudinal studies].

The article presents some of the most relevant results on inequalities in mortality, obtained by the two Italian longitudinal studies carried out in Turin, and Tuscany (in Leghorn and Florence). The two studies share the same methodology. Each database contains census data, information from population register and from death certificates. The authors approach this issue not in an analytical way (as they did in the works cited in the reference list), but answering some questions, relevant both from a scientific and a political point of view. How big are the health inequalities in Italy? Are the health inequalities in Italy increasing or decreasing? Are the health inequalities due to absolute or to relative deprivation? Does the mortality profile of the Italian population express the presence of old or new health inequalities? Can the health inequalities be reduced? The study's results prove that the health inequalities in Italy are deep and strictly related to individuals' position in the social fabric. Facing the other questions the authors focus only in the Turin data. From the 1970's to the 1990's the health inequalities in Turin have increased, despite of general improvement of population's health condition and the progressive reduction of the size of deprived groups. Turin data support both the hypotheses on the source of health inequalities, using long term unemployment as absolute deprivation's indicator, and status' inconsistency as (a row) indicator of relative deprivation. The growth of drug-related causes of death (AIDS and overdose) shows that in the Turin and--quite reasonably--Italian population old and new health inequalities live together. The essay closes offering evidence on the possibility to reduce health inequalities. For this purpose the authors analyses the Turin trend of avoidable deaths and infant and adolescent mortality.

Adult↗

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[The Tuscany longitudinal study: mortality among selected causes in inner city of Florence and Leghorn].

The analysis of mortality in urban settings for the Cities of Florence (1991-95) and Leghorn (1987-95), based on data from the Tuscany Longitudinal Study, is reported in the present paper. The data came from a census-based cohort study, all residents at the census day 1981 (Leghorn) or 1991 (Florence) being enrolled and followed-up by automated procedures of record-linkage. The cause of death certificate had been eventually collected by the Regional Mortality Register. For each city, internally standardized mortality ratios (SMR) had been calculated by sub-urban areas (city sectors or wards). The analysis was restricted to age groups > 15 years to have interpretable results on socio-economic variables derived from census questionnaires. Bayesian estimates (Besag, York e Mollié) of mortality relative risks had been calculated to overcome extra-variability of SMRs. In the city of Florence two wards showed about 10% excess risk for overall mortality. In the city of Leghorn one sector was at higher risk while one showed a significant lower mortality. For both cities such risk gradients were still present after adjustment for deprivation index at individual level.

Adult↗

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[Socioeconomic inequalities in health in the Tuscany Longitudinal Study (SLTO): persistence and changes over time in overall mortality and selected causes (lung cancer, liver cirrhosis, AIDS and overdose)].

We evaluate the persistence of social inequalities in overall mortality or mortality by causes (lung cancer, liver cirrhosis; AIDS and overdose) in the Tuscany Longitudinal Study (SLTo), a record linkage-study on the census population identified at the 1981 and 1991 censuses in Leghorn (1981: 175,741 subjects; 1991: 167,512 subjects), and 1991 in Florence (403,294 subjects), Central Italy. The census data allow an evaluation of socio-economic status of each subject, using variables such as education or occupation, or constructing indexes inclusive of deprivation indexes. Follow-up is from the census up to 1995 and for specific causes of death from 1987 (Leghorn) or 1991 (Florence). Estimates of risk are computed comparing rates of mortality among socio-economic groups, by means of poisson regression models, or by means of Standardized Mortality Ratios using the indirect method. The causes of deaths have been selected mainly because explained by known and strong determinants. As far as overall mortality, the results suggest the persistence of gradients by social class, more often negative among males. Mortality from lung cancer has a strong negative social class gradient among males, and a divergent gradient among women in the two towns, which is interpreted as the effect of a different prevalence of smoking by period, social class and sex. High RRs among lower socio-economic groups have been detected for liver cirrhosis mortality. Excess mortality of AIDS and overdose, an expression of the recent drug crisis, concentrates on the lower social strata and in young adults. Whereas mortality from AIDS has been detected among both sexes, deaths from overdose are occurring among males only. Being AIDS and overdose recent diseases, they stress the persistence of social inequalities over time.

Acquired Immunodeficiency Syndrome↗

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[The incidence of malignant mesothelioma (1977-1996) and asbestos exposure in the population of an area neighboring Lake Iseo, northern Italy].

The study was stimulated by the occurrence of malignant mesotheliomas among the workers of two adjacent factories located in Sarnico, near Lake Iseo (province of Brescia, northern Italy), one of which manufactured crocidolite and chrysotile ropes and gaskets until 1993. The aim of the study was: identification of malignant mesotheliomas occurring between 1977 and 1996 among the residents of 11 villages, which constituted the recruitment area of the work-force; estimation of the incidence of malignant pleural mesothelioma; collection of working histories of all cases to evaluate previous exposure to asbestos and radiation therapy. 21 cases of mesothelioma were detected (20 pleural, 1 peritoneal; 9 among males), and 20 were supported by histopathologic diagnosis. The incidence (x 100,000 person-years, standard: European population) was 2.5 (0.7-4.2) and 2.8 (1.2-4.3) among males and females, respectively, corresponding to a three-fold increase among males and a more than ten fold increase among women in comparison with the incidence reported by the Lombardy Cancer Registry. No cases had been exposed to radiation therapy, whereas all cases had been occupationally exposed to asbestos. Occupational exposure to asbestos had occurred in work on the production of crocidolite and chrysotile ropes and gaskets (6 males); in work in a textile factory producing cotton garments that was adjacent to and polluted by the former, where, in addition, chrysotile blankets were used for fireproofing in the weaving area and pipes were insulated using amosite-containing materials (10 cases, 6 among females); 5 cases occurred among women working in silk factories, where asbestos exposure was possible because of the presence of pipes insulated with asbestos and because women were handling temperature-controlled trays insulted with asbestos. In conclusion, the study demonstrated that the occurrence of mesothelioma was higher among females than males in the study area and that all cases of mesotheliomas had been occupationally exposed to asbestos.

Age Distribution↗

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[Trends in mortality from primary pleural tumor and incidence of pleural mesothelioma in Italy: a particularly serious situation].

We present: a) an analysis of the past mortality from Primary Pleural Tumors (PPT) occurred in Italy between 1968 and 1992 by an age-cohort-period model, using a Poisson regression model, estimating the risk of dying by birth cohort, the Lifetime Cumulative risk (25-84 years) by birth cohort, the risk by calendar period and testing the full model (age-cohort-period effects); b) a summary of the incidence of mesothelioma as recorded in Italy by Cancer Registries and Mesothelioma Registries. The highest Lifetime Cumulative Risk of dying from TTP is recorded for the birth cohort 1946-'50 (6.2 per thousand among males, 1.64 among females). Whereas the risk by birth cohort becomes flat among females born after 1936, among males the risk is increasing up to the youngest birth cohorts. By calendar period, the highest risk of dying is observed in the last period (1991-'92). The inclusion in the full model of the calendar period term increases significantly the goodness-of-fit of the model among females, but not among males. The highest incidence of mesothelioma in both genders registered by 150 Cancer Registries all over the world is currently recorded among the population of Genoa and Trieste, where large ship-building plants are located. Even higher incidence mesothelioma rates have been recently recorded in other areas of Italy. The trend in PPT mortality in Italy could have been influenced, but not explained, by the increased awareness over time of the disease, but it fits well with the pattern occurring in most industrialized countries of western Europe, with the unprotected industrial use of asbestos which occurred in Italy, and also with the gender characteristics of the work-force employed in asbestos-exposing activities. A ban of asbestos use has been introduced in Italy in 1992. However, considering that asbestos seems to act as an initiator for mesothelioma, the trend in male mortality for PPT will not peak until two or three decades.

Adult↗

PubMedDate not supplied

[Mortality in employees of a railway rolling stock factory].

A study was carried out on the mortality of 3741 individuals who worked in a factory making railway rolling stock, in which crocidolite was used to insulate the coaches in the 60's and 70's. Employees who had worked in the factory between 1960 and 1995 were included in the study, with the main aim of investigating cancer mortality in these subjects. 9 cases of mesothelioma were known in this factory before starting the study. The follow-up was performed from 1960 to 1996. The SMR's for lung cancer and mesothelioma in 2737 blue-collar workers were 1.23 (CI 95% = 1.00-1.50) and 6.50 (CI 95% = 2.96-12.38) respectively, based on national rates. The excesses were mainly found among subjects who had worked before 1970 with duration of employment exceeding 20 years.

Cause of Death↗

PubMedDate not supplied

[Identification and mortality of Italian emigrants returning to Italy after having worked in the crocidolite mines at Wittenoon Gorge, Western Australia].

The crocidolite mine at Wittenoom Gorge, Western Australia, has been active from 1943 to 1966, and managed by Australian Blue Asbestos Ltd (ABA). Migrants constituted the large majority of workers. The list of workers is composed of 6,911 subjects (6,501 males). In it we identified 1,102 Italians (1,069 males) and completed the follow up for those previously lost, remained in Australia or returned to Italy. Up to 1997, 302 subjects (301 males) definitively resettled in Italy, almost always returning to their community of origin. The median length of work at Wittenoom for those resettled was 17.8 months. The resettled subjects are spread around Italy, and 112 subjects (37%) already died. We compared the mortality rates of those returned to Italy to the rates of the male Italian population. Migrants were subjected to a strong selection before departure and were the target of a surveillance program during work at Wittenoom: however, for those resettled, instead of a healthy migrant effect, we observed an overmortality, mainly due to deaths from penumoconiosis (10 deaths vs 0.38 expected), from respiratory tumours (3 deaths from pleural mesothelioma and 4 from primary peritoneal tumours; an excess of lung cancers, SMR 1.28, 95% CI 0.72-2.11, and an excess of undefined caused of deaths (SMR 6.29, 95% CI 2.52-12.96). The study suggests that asbestos-related diseases and deaths have been observed among those resettled to Italy. In order to increase the precision of the follow up of the Wittenoom cohort, a search outside Australia should be carried out in some European countries for workers whose vital status was unconfirmed. Survivors in Italy are suffering from asbestosis, jeopardizing their life, and are at risk of cancer, but few have received information, actions aimed at reducing the accumulated risk, or compensation. Italy had a multi-million number of migrants for work, and an important percentage of migrants is returned to Italy: the effects of occupational exposures to adverse agents should be expected, but this topic has received up to now little attention.

Adult↗

PubMedDate not supplied

[Pleural mesothelioma in women in the Veneto Region who used to work as rag sorters for textile recycling and paper production].

The paper reports 9 cases of mesothelioma diagnosed by means of histology or cytology that were observed among women resident in the Veneto Region, Northern Italy, whose only activity that could involve exposure to asbestos was as rag sorter. These cases are part of a group of about 260 subjects with mesothelioma whose entire working and residential history has been collected. The women worked as rag sorters between the 1940's and 1960's in textile recycling (8 cases) or (one case) at a paper mill where cotton was used for paper production. The work as rag sorter helps to explain the high proportion of mesotheliomas among women with an occupational exposure to asbestos.

Aged↗

PubMedDate not supplied

[Return of immigrants: a cluster analysis of mesotheliomas among residents of the Veneto region who used to work at the ETERNIT AG factory at Niederurnen, Switzerland].

We identified 5 mesotheliomas among Italian migrant workers who returned home and settled in the Veneto Region, after employment at the ETERNIT AG factory in Switzerland. During the 1970s the factory employed about 1000 workers and the presence of Italian migrants was relevant. The cluster confirms that migration for work has caused exposures to carcinogenic substances and confirms that neoplastic diseases are occurring among those resettled in Italy and helps explaining the high occurrence of mesotheliomas in this country.

Catchment Area, Health↗

PubMedDate not supplied

[Tuscany mesothelioma registry (1988-2000): evaluation of asbestos exposure].

BACKGROUND: The Tuscany Mesothelioma Register (ARTMM) records pleural malignant mesothelioma cases of Tuscany residents, diagnosed by histological, cytological, or clinical (radiography or computerized tomography) examinations. The ARTMM began in 1988 and estimates mesothelioma incidence in Tuscany and collects information on past asbestos exposure of mesothelioma cases. OBJECTIVES: The aim of this paper was to describe the incidence of pleural mesothelioma cases in Tuscany and to analyse their possible past asbestos exposures. METHODS: We considered pleural mesothelioma cases recorded in ARTMM in the period 1988-2000 and interviews collected for these cases. In order to identify past asbestos exposure in the occupational and non-occupational history of patients, interviews were carried out using a standardised questionnaire. RESULTS: In the period 1988-2000, 494 pleural malignant mesothelioma cases were recorded in the ARTMM; 82% were males. In the periods 1988-1993, 1994-1997, 1998-2000 the incidence rates, standardised on the Italian population (per 100,000), were respectively 1.15, 1.57, 2.58 among males; 0.29; 0.27; 0.29 among females. Information on occupational history was collected for 418 mesothelioma patients (85% of recorded cases): 173 mesothelioma cases were directly interviewed; for 245 cases relatives or work colleagues were interviewed. Occupational asbestos exposure was ranked as certain, probable or possible in 72% of the interviewed cases (80% of males; 20% of females). Environmental and non-occupational asbestos exposure was identified in 1% of males, and 3% of females. In 24% of the interviewed cases (15% of males; 74% of females) no known asbestos exposure was identified. Occupational asbestos exposure occurred in maritime activities (shipyards, dock work, merchant and regular Navy), the building industry, railway carriage construction and maintenance, rail transport, textile industries (mainly rag sorting), electricity production, asbestos cement manufacture, chemical, iron and steel industries and in glass manufacturing. In Tuscany two areas are distinguished for their well-documented and massive use of asbestos: the coastal areas (Livorno and Massa Carrara) for maritime activities, and the areas of Pistoia and Arezzo for railway carriage construction and repair. Mesothelioma incidence rates in these areas are the highest in the whole region. CONCLUSIONS: Further investigation is needed in order to identify unknown asbestos uses and consequent exposure, in particular for females. Uncertainty as regards occurrence of asbestos exposure persists in the textile industries where the mesothelioma epidemics have not yet declined. Research hypotheses are addressed on the re-use of jute bags previously containing asbestos, therefore collection of further information on periods and methods of this recycling activity is essential.

Adult↗

PubMedDate not supplied

[Exposure to asbestos and Decree 277].

Explore the source record for details and available documents.

Asbestos↗

PubMedDate not supplied

Epidemiologic surveillance for primary prevention of malignant mesothelioma: the Italian experience.

BACKGROUND: The Italian National Mesothelioma Registry (ReNaM) was set up at the National Institute for Occupational Safety and Health (ISPESL) to estimate Italian incidence of malignant mesothelioma (MM), define modalities of asbestos exposures, assess impact and diffusion of MM, identify underestimated sources of environmental contamination. OBJECTIVES: To describe ReNaM activity, database dimension and epidemiological characteristics of the caselist. METHODS: Regional Operating Centers (COR) in 16 Italian regions were set up to identify and investigate all cases of MM diagnosed in each region, applying national guidelines. COR collect cases in health care institutions. Occupational history, lifestyle and residence are obtained by direct interview using a standard questionnaire. Exposure modalities are classified by industrial hygienists, evaluating whether work, private life or any particular environmental condition could have involved asbestos exposure. RESULTS: Data refer to 3,446 cases collected in 9 Italian regions during 1993-2001. Pleural mesothelioma affected 94% cases, pleural/peritoneal ratio was 16:1. Gender ratio (M/F) was 2.7:1 (1.3:1 for peritoneum). There was a variety of occupational exposures, some already known as high risk sectors and others unexpected. The most common exposures occurred in building and construction, metallurgy and steel, shipbuilding, and railway stock. High risk categories were encountered such as bricklayers, plumbers, carpenters, electricians, welders, installers and maintenance workers in metallurgy and the steel industry, general labourers, tool makers and painters in shipbuilding/repair/demolition. CONCLUSIONS: Despite some ReNam's limitations, identification of MM cases and analysis of modality of exposure, with standardized criteria, are a fundamental tool for primary prevention of asbestos related diseases.

Asbestos↗

PubMedDate not supplied

[Tumors of the excretory urinary tract in workers of the textile industry in the Prato area].

A hospital-based case-control study on bladder and lower urinary tract cancers was conducted in the Prato area, where the textile industry is the main manufacturing sector (about 50,000 employees). "Cases" were male subjects, aged over 15 years in whom urothelial cancer had been diagnosed in the period 1980-1985; controls (two for each case) were subjects of the same sex and age with other urological diseases or cancer of the prostate or testis. Cases and controls were interviewed via a questionnaire on occupational history and personal habits. A positive association was found for subjects who had worked in the textile industry (O.R. = 1.42; C.I. = 1.0-2.0). Analysis by job titles showed positive association for "rag selectors" (O.R. = 4.09; C.I. = 1.39-11.96), whereas no association was found for dyers (O.R. = 0.74; C.I. = 0.29-1.87).

Adolescent↗