In Italy the National Registry of Mesothelioma ReNaM reporte
In Italy, the National Registry of Mesothelioma (ReNaM) reported 21,463 incident cases of MM in 1993–2012, about 1,073/year; out of them, 93% were pleural mesothelioma cases. The routes of exposure to asbestos was ascertained for 77% of MM cases: among those, 10.5% were non-occupational (including 4.2% environmental), whereas 69.5% were occupational exposures .
The World Health Organization (WHO) has declared that asbestos-related diseases should be eliminated throughout the world . Developing national programmes to eliminate asbestos-related diseases was a point of the final Declaration of the Sixth Ministerial Conference on Environment and Health of WHO European Region, in order to achieve the health and well-being objectives of United Nations 2030 Agenda for Sustainable Development .
The purpose of the present paper is to show geographical distribution and temporal trend of mortality for all malignant mesothelioma (MM) and, specifically, for malignant pleural mesothelioma (MPM), in Italian Regions and municipalities. The investigation is part of a permanent epidemiological surveillance, that started at the beginning of the Nineties [, , , , ]. The estimates performed at national level could contribute to the estimates of the global burden of mesothelioma and of the health impact of asbestos in the world.
Materials and methods Lastly, we computed the sex ratio (Men/Women) of the cases deceased for MM and MPM in three Tirapazamine of municipalities at different degrees of population density, like defined by EUROSTAT (http://ec.europa.eu/eurostat). The analysis was performed in Italy and in geographical macro-areas used in clustering analysis. The rationale of this analysis was to test a possible excess of female patients in urban areas reflecting a higher urban versus rural environmental asbestos concentrations (buildings, traffic).
Results In Italy, between 2003 and 2014, 16,086 persons (about 1,340/year) died for MM, corresponding to 2.19/100,000 inhabitants (95% CI:2.15-2.22): 11,487 men (3.65/100,000) and 4599 women (1.09/100,000). Among those, we found 13,051 cases (1,087/year) of MPM (1.77/100,000): 9397 men and 3654 women, with a corresponding rate of 2.98/100,000 and 0.86/100,000. The remaining deaths for MM include mesothelioma of peritoneum, pericardium, other sites and unspecified mesothelioma (Table 1). Temporal trends from 2003 to 2014 of the standardized rates of MM and MPM mortality are statistical significant increasing (p ≤ 0.001) in the overall population and, particularly, in men (Fig. 1). Fig. 2, Fig. 3 show the distribution of regional standardized MM and MPM mortality rates in male and female population, separately. Northern Regions (Liguria, Piemonte, Friuli Venezia Giulia, Lombardia and Valle d’Aosta) have mortality rates for MM and MPM higher than the national ones. Table 2 shows standardized rates and SRR for each geographical macro-areas used in cluster analysis. Fig. 4, Fig. 5 show the maps of significant clusters (p-value<0.10) of MM and MPM mortality detected in the macro-areas, separately by gender. Their characteristics and the municipalities included in each cluster are described in Supplementary files (S1, S2, S3, S4). Table 3 shows the sex ratio (male/female cases) of MPM deaths, in the three different classes of population density. The ratio Men/Women for MPM deaths in Italy is 2.58, with no differences between the three classes. This finding does not support the hypothesis of an excess risk of mesothelioma in women living in urban areas associated to asbestos exposure in dwellings or generated by traffic.
Discussion Preliminarily to a comment of the study findings in public health terms, some caution in data interpretation must be recommended, in light of two sources of uncertainty: possible misclassification of the causes of death and low statistical power due to the rarity of mesothelioma. Both these issues were discussed in the previous reports on mesothelioma mortality in Italy [15,16]. Misclassification associated with death certification was reduced with transition (in Italy, in 2013) from the 9th to the 10th Revision of the International Classification of Diseases (ICD). The previously used topographic code corresponding to “Malignant neoplasms of pleura” was substituted by a morphological one (“Malignant pleural mesothelioma”), which determined a more stringent requirement and thus a reduction in the total number of cases. The statistical power progressively increased over time (the present time series based on ICD-10 currently covers 12 years). In this frame, taking into account some prudence in interpreting mesothelioma mortality data, some public health oriented comments appear to be warranted.