Cluster Analysis of Mortality in an Area of Campania Region (Italy), with Intense Environmental Pressure due to Waste

Abstract

ISEE-0818 Background and Objective: Different health effects have been repeatedly associated with residence close to waste landfill sites. The Campania region experienced a long period waste crisis including widespread illegal practice of dumping toxic and urban waste. In that area, statistically significant clusters of mortality by lung, liver, gastric, kidney and bladder cancers and of selected congenital malformations have been reported (Fazzo et al. 2008); many of these outcomes resulted spatially correlated with an intensity index of waste-related exposure (Martuzzi et al. 2009). The objective is to investigate whether non-cancer mortality causes show a tendency for clustering in the waste dumping areas. Methods: Cluster analyses of causes of death (ICD-9) were performed for diabetes (250), circulatory (390–459), myocardial infarction (410–414), cerebrovascular (430–438), respiratory (460–519), digestive (520–579), cirrhosis (571), urogenital (580–629). The unit of the study consists of the 196 municipalities of the Provinces of Naples and Caserta. Mortality data were retrieved from the Italian National Institute of Statistics for 1994–2001. Cluster analysis by Spatial Scan Statistics using 5 km maximum radius of circular cluster was performed. The population resident in the provinces of Naples and Caserta, excluding Naples, was used as standard. For each gender SMR was standardized for age and deprivation index. Results: Among 15 statistically significant most likely clusters emerged, 11 included sub-areas at higher waste risk: mortality due to diabetes, circulatory, myocardial infarction, cerebrovascular diseases for men and women, respiratory for women, digestive and cirrhosis for men. The observed/expected ratio ranged from 1.2 for myocardial infarction in men and women to 2.9 for cerebrovascular causes in women. Conclusion: The clustering results indicate associations between some non-cancer mortality causes and residence in waste disposal areas similar to those described for cancer mortality. Many other risk factors can play a role and ad-hoc analytical studies need to be carried out.