Fazzo Lucia, Minelli Giada, De Santis Marco, Bruno Caterina, Zona Amerigo, Conti Susanna, Comba Pietro
Dept of Environment and Health, Istituto Superiore di Sanità, viale Regina Elena, 299 - 00161 Roma, Italy.
Statistical Service, Istituto Superiore di Sanità, viale Regina Elena, 299 - 00161 Roma, Italy.
Cancer Epidemiol. 2018 Aug;55:184-191. doi: 10.1016/j.canep.2018.06.010. Epub 2018 Jul 7.
Malignant mesothelioma (MM) is causally linked to asbestos exposure with an estimated etiological fraction of 80% or more.
Standardized rates of all mesothelioma (C45, ICD-10) and malignant pleural mesothelioma (C45.0, ICD-10) mortality in Italy were computed at national and regional levels, for the period 2003-2014. Standardized Mortality Ratios (SMRs, with 95% Confidence Intervals) were calculated for each of the 8047 Italian municipalities, for both diseases, with respect to Regional figures. A geographical clustering analysis at municipal level was performed, applying SatScan methods.
In Italy, 16,086 persons (about 1,340/year) died for MM, in analysed period. National Standardized rates of MM mortality are 3.65/100,000 in men and 1.09/100,000 in women, with an increasing annual trend, among male population. The highest rates were found in men from Northern Regions. Significant clusters (p < 0.10) were found corresponding to areas that hosted major asbestos-cement plants, naval shipyards, petrochemical plants and refineries. Furthermore, excesses were found corresponding to chemical and textile industries; the latter involving, particularly, female population. Excesses were found also in areas near the chrysotile mine of Balangero, and in Biancavilla, a town with a stone quarry contaminated by fluoro-edenitic fibres; an excess of MM mortality was observed among male population living in a minor island where a Navy shipyard is located.
Mortality for mesothelioma in Italy is still increasing, twenty-six years after the asbestos ban. Epidemiological surveillance of mesothelioma mortality allows to detect the temporal trend of the disease and highlights previously unknown or underestimated sources of asbestos exposure.
恶性间皮瘤（MM）与石棉暴露存在因果关联，估计病因分数达80%或更高。
计算了2003 - 2014年期间意大利全国和地区层面所有间皮瘤（国际疾病分类第十版，C45）和恶性胸膜间皮瘤（国际疾病分类第十版，C45.0）的标准化死亡率。针对这两种疾病，以地区数据为参照，计算了意大利8047个市镇各自的标准化死亡比（SMR，含95%置信区间）。应用时空扫描方法进行了市镇层面的地理聚集分析。
在分析期内，意大利有16,086人（约每年1340人）死于MM。MM死亡率的全国标准化率男性为3.65/10万，女性为1.09/10万，在男性人群中有上升的年度趋势。最高发病率出现在北部地区的男性中。发现了与主要石棉水泥厂、海军造船厂、石化厂和炼油厂所在区域相对应的显著聚集区（p < 0.10）。此外，在化工和纺织行业所在区域也发现了超额发病情况；后者尤其涉及女性人群。在巴兰杰罗温石棉矿附近地区以及比安卡维拉（一个因氟钙闪石纤维污染采石场的城镇）也发现了超额发病情况；在一个有海军造船厂的小岛上居住的男性人群中观察到MM死亡率过高。
在石棉禁令实施26年后，意大利间皮瘤死亡率仍在上升。间皮瘤死亡率的流行病学监测有助于检测该疾病的时间趋势，并突出以前未知或被低估的石棉暴露源。
