Abstract
BackgroundPrevious ecological spatial studies of malignant mesothelioma cases, mostly based on mortality data, lack reliable data on individual exposure to asbestos, thus failing to assess the contribution of different occupational and environmental sources in the determination of risk excess in specific areas. This study aims to identify territorial clusters of malignant mesothelioma through a Bayesian spatial analysis and to characterize them by the integrated use of asbestos exposure information retrieved from the Italian national mesothelioma registry (ReNaM).MethodsIn the period 1993 to 2008, 15,322 incident cases of all-site malignant mesothelioma were recorded and 11,852 occupational, residential and familial histories were obtained by individual interviews. Observed cases were assigned to the municipality of residence at the time of diagnosis and compared to those expected based on the age-specific rates of the respective geographical area. A spatial cluster analysis was performed for each area applying a Bayesian hierarchical model. Information about modalities and economic sectors of asbestos exposure was analyzed for each cluster.ResultsThirty-two clusters of malignant mesothelioma were identified and characterized using the exposure data. Asbestos cement manufacturing industries and shipbuilding and repair facilities represented the main sources of asbestos exposure, but a major contribution to asbestos exposure was also provided by sectors with no direct use of asbestos, such as non-asbestos textile industries, metal engineering and construction. A high proportion of cases with environmental exposure was found in clusters where asbestos cement plants were located or a natural source of asbestos (or asbestos-like) fibers was identifiable. Differences in type and sources of exposure can also explain the varying percentage of cases occurring in women among clusters.ConclusionsOur study demonstrates shared exposure patterns in territorial clusters of malignant mesothelioma due to single or multiple industrial sources, with major implications for public health policies, health surveillance, compensation procedures and site remediation programs.Electronic supplementary materialThe online version of this article (doi:10.1186/s12885-015-1301-2) contains supplementary material, which is available to authorized users.
Highlights
Previous ecological spatial studies of malignant mesothelioma cases, mostly based on mortality data, lack reliable data on individual exposure to asbestos, failing to assess the contribution of different occupational and environmental sources in the determination of risk excess in specific areas
This study aims to identify territorial clusters of MM cases in Italy through a Bayesian spatial analysis and to characterize them for exposure patterns by integrated use of individual asbestos exposure information retrieved from the Italian national mesothelioma registry (ReNaM)
A total of 15,322 incident cases of all-site malignant mesothelioma were analyzed from the registry of malignant mesothelioma (ReNaM), accounting for 96.7% (15,322/15,845) of all cases recorded in the 1993–2008 period
Summary
Previous ecological spatial studies of malignant mesothelioma cases, mostly based on mortality data, lack reliable data on individual exposure to asbestos, failing to assess the contribution of different occupational and environmental sources in the determination of risk excess in specific areas. This study aims to identify territorial clusters of malignant mesothelioma through a Bayesian spatial analysis and to characterize them by the integrated use of asbestos exposure information retrieved from the Italian national mesothelioma registry (ReNaM). Asbestos production reached a peak in the 1976–1980 period, but remained steadily over 100,000 tons/year until 1987. Asbestos imports still exceeded 50,000 tons/ years in 1991. These temporal patterns made the peak in asbestos consumption later in Italy than in other European countries and in the United States [5]. Considering the long latency of MM (generally around 35–40 years from first exposure), a high number of cases is still expected in Italy in the few decades [6]
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