Martuzzi M, Mitis F, Pirastu R, Iavarone I, Pasetto R, Musmeci Loredana, Zona Amerigo, Conti Susanna, Bianchi Fabrizio, Forastiere Francesco, Comba Pietro
World Health Organization Regional Office for Europe, Rome, Italy.
Epidemiol Prev. 2011 Sep-Dec;35(5-6 Suppl 4):153-62.
SENTIERI Project has assessed the overall mortality profile in all the IPSs combined, and performed IPS-specific analyses. The epidemiological evidence of the causal association between cause of death and exposure was classified into one of these three categories: Sufficient (S), Limited (L) and Inadequate (I). The procedures and results of the evidence evaluation have been presented in a 2010 Supplement of Epidemiology & Prevention devoted to SENTIERI. Mortality for causes of death with a priori Sufficient or Limited evidence of association with the environmental exposure exceeds the expected figures, with a SMR of 115.8 for men (90%CI 114.4-117.2; 2 439 extra deaths) and 114.4 for women (90% CI 112.4-116.5; 1 069 extra deaths). These excesses are also observed when analysis is extended to all the causes of death (i.e. with no restriction to the ones with a priori Sufficient or Limited evidence): for a total of 403 692 deaths (men and women combined), an excess of 9 969 deaths is observed, with an average of around 1 200 extra deaths per year. Most of these excesses are observed in IPSs located in Southern and Central Italy. The distribution of the causes of deaths shows that the excesses are not evenly distributed: cancer mortality accounts for 30%of all deaths, but is 43.2%of the excess deaths (4 309 cases of 9 969). Conversely, the percentage of excesses in non cancer causes, 19%, is lower than their share of total mortality (42%). Consistently with previous studies, the results suggest that the health status of populations living in the IPSs is worse than what regional averages show. Compared to previous studies, the analysis of the causes selected in SENTIERI, on the basis of a priori Sufficient or Limited evidence of association with the environmental exposures, provides additional information on their role, though some limitations, due to methodology and data used, should be considered.
SENTIERI项目评估了所有综合职业卫生服务机构（IPSs）的总体死亡率情况，并进行了特定IPS的分析。死亡原因与暴露之间因果关联的流行病学证据被归类为以下三类之一：充分（S）、有限（L）和不充分（I）。证据评估的程序和结果已在2010年《流行病学与预防》关于SENTIERI的增刊中公布。对于与环境暴露关联证据先验充分或有限的死亡原因，其死亡率超过预期数字，男性的标准化死亡比（SMR）为115.8（90%置信区间114.4 - 117.2；额外死亡2439例），女性为114.4（90%置信区间112.4 - 116.5；额外死亡1069例）。当分析扩展到所有死亡原因时（即不限于先验充分或有限证据的那些原因），也观察到了这些超额情况：在总共403692例死亡（男性和女性合计）中，观察到超额死亡9969例，平均每年约有1200例额外死亡。这些超额情况大多出现在意大利南部和中部的职业卫生服务机构中。死亡原因的分布表明，超额情况并非均匀分布：癌症死亡率占所有死亡的30%，但在超额死亡中占43.2%（9969例中的4309例）。相反，非癌症原因的超额百分比为19%，低于它们在总死亡率中的占比（42%）。与之前的研究一致，结果表明生活在职业卫生服务机构中的人群健康状况比地区平均水平更差。与之前的研究相比，基于与环境暴露关联的先验充分或有限证据对SENTIERI中选定原因的分析，提供了关于它们作用的额外信息，不过由于所使用的方法和数据，应考虑一些局限性。
