Minichilli Fabrizio, Bustaffa Elisa, Manno Valerio, Benedetti Marta, Contiero Paolo, Iavarone Ivano, Maraschini Alice, Minelli Giada, Pasetto Roberto, Ricci Paolo, Zona Amerigo, Fazzo Lucia
Institute of Clinical Physiology, National Research Council, Pisa, Italy.
Statistical Service, Istituto Superiore di Sanità, Roma, Italy.
BMC Public Health. 2025 May 30;25(1):1997. doi: 10.1186/s12889-025-22997-6.
Contaminated sites are among the main worldwide environmental health priorities. The health impact on population living in Italian contaminated sites of national concern for remediation (CSs) with petrochemical/refineries (P&R) and steel plants (S) was estimated. Since these CSs include the major Italian facilities located widespread on the territory are representative of the national reality. Furthermore, the population exposed in P&R and S is significant since it represents about 3% of the national population.
Two groups of CSs were defined: twelve CSs with P&R and eight with S. Cause-specific mortality (2013-2017) and hospitalization (2014-2018) in both groups were analysed. Pooled Standardized Mortality/Hospitalization Ratios (SMR/SHR) were estimated through random-effect meta-regression of individual site SMR/SHR (reference: CS regional rate). The main groups of diseases and those for which the evidence of an association with the residential exposure to P&R and S was defined limited were analysed in adult while only the main groups of diseases were analysed in paediatric-adolescent and juvenile ages subgroups (0-1, 0-19, 20-29 years). All the analyses were performed separately for the two groups of CSs, and by sex.
In the two CSs groups, the overall and the main causes mortality and hospitalization, including all cancers, exceeded in both sexes. Specifically, for lung cancer in the P&R group, among males SMR=1.11 (CI90% 1.00-1.23) and SHR=1.18 (0.99-1.40) and among females SMR=1.13 (1.03-1.25) and SHR=1.20 (1.05-1.38), while in the S group, SMR=1.17 (1.02-1.34) and SHR=1.27 (0.87-1.86) among males and SMR=1.21 (0.93-1.59) and SHR=1.19 (0.91-1.57) among females. The mortality and hospitalization exceeded also for breast cancer in the P&R group. Hospitalization for leukaemia and respiratory diseases increased in the S group. In both CSs groups, among 20-29 years old sub-population, mortality for all tumours and hospitalization for respiratory diseases was worthy of note and hospitalization for all tumours exceeded among 0-1-year age-subgroup.
The results suggest that living in petrochemical/refineries and steel plants CSs is associated with increased risk for specific diseases. The meta-analytical estimates could contribute to assess the order of magnitude of health impacts of contaminated sites and to perform integrated evaluation of health and environmental impact.
受污染场地是全球主要的环境卫生优先事项之一。对居住在意大利受关注的、需进行修复的受污染场地（CSs）中，与石化/炼油厂（P&R）和钢铁厂（S）相关区域人群的健康影响进行了评估。由于这些CSs包含了意大利分布广泛的主要设施，具有全国代表性。此外，暴露于P&R和S区域的人群数量可观，约占全国人口的3%。
定义了两组CSs：12个与P&R相关的CSs和8个与S相关的CSs。分析了两组在特定病因下的死亡率（2013 - 2017年）和住院率（2014 - 2018年）。通过对各场地标准化死亡率/住院率（SMR/SHR）（参考：CS区域率）进行随机效应meta回归来估计合并的标准化死亡率/住院率。在成年人中分析了主要疾病组以及与居住暴露于P&R和S相关证据有限的疾病组，而在儿童 - 青少年和青少年年龄亚组（0 - 1岁、0 - 19岁、20 - 29岁）中仅分析了主要疾病组。所有分析针对两组CSs分别进行，并按性别分类。
在两组CSs中，总体及主要病因的死亡率和住院率在两性中均超过正常水平。具体而言，对于P&R组中的肺癌，男性SMR = 1.11（CI90% 1.00 - 1.23），SHR = 1.18（0.99 - 1.40）；女性SMR = 1.13（1.03 - 1.25），SHR = 1.20（1.05 - 1.38）。而在S组中，男性SMR = 1.17（1.02 - 1.34），SHR = 1.27（0.87 - 1.86）；女性SMR = 1.21（0.93 - 1.59），SHR = 1.19（0.91 - 1.57）。P&R组中乳腺癌的死亡率和住院率也超过正常水平。S组中白血病和呼吸道疾病的住院率有所上升。在两组CSs中，20 - 29岁亚人群中所有肿瘤的死亡率和呼吸道疾病的住院率值得关注，0 - 1岁年龄亚组中所有肿瘤的住院率超过正常水平。
结果表明居住在石化/炼油厂和钢铁厂的受污染场地与特定疾病风险增加有关。meta分析估计有助于评估受污染场地对健康影响的量级，并对健康和环境影响进行综合评估。
