SENTIERI Project Research Articles

Environment and Health in Contaminated Sites: The Case of Taranto, Italy

The National Environmental Remediation programme in Italy includes sites with documented contamination and associated potential health impacts (National Priority Contaminated Sites—NPCSs). SENTIERI Project, an extensive investigation of mortality in 44 NPCSs, considered the area of Taranto, a NPCS where a number of polluting sources are present. Health indicators available at municipality level were analyzed, that is, mortality (2003–2009), mortality time trend (1980–2008), and cancer incidence (2006-2007). In addition, the cohort of individuals living in the area was followed up to evaluate mortality (1998–2008) and morbidity (1998–2010) by district of residence. The results of the study consistently showed excess risks for a number of causes of death in both genders, among them: all causes, all cancers, lung cancer, and cardiovascular and respiratory diseases, both acute and chronic. An increased infant mortality was also observed from the time trends analysis. Mortality/morbidity excesses were detected in residents living in districts near the industrial area, for several disorders including cancer, cardiovascular, and respiratory diseases. These coherent findings from different epidemiological approaches corroborate the need to promptly proceed with environmental cleanup interventions. Most diseases showing an increase in Taranto NPCS have a multifactorial etiology, and preventive measures of proven efficacy (e.g., smoking cessation and cardiovascular risk reduction programs, breast cancer screening) should be planned. The study results and public health actions are to be communicated objectively and transparently so that a climate of confidence and trust between citizens and public institutions is maintained.

ANALYSIS OF HOSPITAL DISCHARGE DATA TO DESCRIBE HEALTH STATUS OF RESIDENTS IN ITALIAN POLLUTED SITES

Background and Aims: This study derives from SENTIERI Project, aimed at implementing a multi-disciplinary and multi-phase process leading to a full epidemiological characterization of Italian Polluted Sites (IPSs). SENTIERI Project analyzed mortality of residents in 44 IPSs for 63 causes of death, for which the epidemiologic evidence indicated a potential association with pollution in IPSs. The aim of the present study is to analyze hospital discharge data of residents in IPSs, with special focus on causes already studied in SENTIERI Project. Methods: Hospital Discharge Record (HDR) is a synthesis of the patient’s medical record and it is mandatory for both in-patients and out-patients and contains, for each hospital discharge in Italy, social and demographic data of the patient (i.e. age, gender, place of birth, place of residence) and clinical data (“main” diagnosis and up to 5 other diagnoses, procedures, outcomes). Diagnoses and procedures are coded using the International Classification of Diseases, 9th revision, Clinical Modification (ICD-9 CM). HDR data referring to year 2008 were analyzed calculating standardized hospitalization rates and relative risks (RR) using as reference the Region where the IPS is situated. Results: As an example, Gela area (South of Italy), where a large chemical/petrochemical complex is located, shows significantly increased risks of hospitalization for all causes (RR=1.29, 95%CI 1.26-1.31), all tumors (RR 1.10, 95%CI 1.04-1.18), circulatory (RR=1.25, 95% CI 1.20-1.30) and respiratory diseases (RR=1.24, 95% CI 1.17-1.31), as also found for the mortality analysis. Conclusions: In order to characterize the health status of IPSs residents, besides mortality data, HDR have to be analyzed. HDR have been created for administrative purposes and thus not necessarily contain complete clinical data but they do have potentials, such as the international system of codification used and the routinely and exhaustive collection, with no additional resources necessary.

SENTIERI project: mortality study of residents in Italian polluted sites – IPS

Background and Aims: Soil contamination occurs in approximately 250,000 sites in the European Environment Agency member countries. In Italy several thousands qualify for remediation and 57 are defi...

SENTIERI – OCCUPATIONAL EXPOSURE CONTRIBUTION TO MORTALITY: THE CASE OF MASSA CARRARA POLLUTED SITE

Background and Aims: SENTIERI project is aimed to describing health status of resident populations in Italian polluted sites defined as “of national concern” (Ministerial Decree n. 486, 2001, and successive Decrees) using mortality data. Identified sources of contamination were categorized as chemical industry, petrochemical plants & refineries, harbour area, asbestos or other mineral fibers, steel plants, thermoelectric power plants, mines or quarries, landfills, incinerators. Sixty-three groups of causes of death (ICD IX) were selected. Methods: A descriptive analysis (1995-2002) of mortality for both gender was performed calculating Standardised Mortality Ratio (SMR), crude and adjusted for deprivation (90% Confidence Intervals). Regional population was used for comparison. SENTIERI adopted an a priori definition of contaminated site and an a priori evaluation of the epidemiological evidence of the association between environmental exposure/s and cause specific mortality. Epidemiologists in working group examined bibliographic information, assessing the presence of a causal association between environmental exposure/s and cause specific mortality following standardised criteria. Evidence was classified as: Sufficient or Limited to infer the presence of a causal association, Inadequate to infer the presence or absence of a causal association. To take account of occupational exposures, authoritative publications were considered. Results: As an example, the case of Massa Carrara will be presented, as it is among the most complex polluted sites in terms of environmental contamination (asbestos, production of chemical substances, harbour area, incinerator, petrochemical plant and/or refinery, steel industry). Increased risk of death from several causes were found: diseases of cardiovascular, respiratory and digestive systems, malignant neoplasms of liver, lung, pleura. Conclusions: The potential contribution of previous occupational exposures to overall mortality in the polluted sites should not be overlooked, and the a priori SENTIERI approach seems to be fruitful.

MORTALITY ANALYSIS IN ITALIAN POLLUTED SITES (IPS) WITH INDUSTRIAL WASTE LANDFILLS AND DUMPING SITES

Background and Aims: SENTIERI project describes mortality in 44 Italian polluted sites (IPS) –of national concern” for their contamination documented in Ministerial Decrees. IPS are classified for ...

Multicentre Mortality Study of Contaminated Sites of National Concern in Italy

S-29B6-3 Background/Aims: Soil contamination requiring clean-up occurs in approximately 250,000 sites in the European Environment Agency-EEA member countries; several thousand sites qualify for remediation in Italy, 57 of them are defined as “of national concern” for the entity of the documented contamination. SENTIERI project, funded by the Italian Ministry of Health, aims at describing sources of environmental pollution in Italian contaminated sites and health status of resident populations using mortality data. Methods: In all, 44 sites were selected for analyses (298 municipalities, 5.5 million inhabitants, about 10% of Italian population at 2001 census). These sites were classified based on the presence of environmental exposure/s as documented in the Ministerial Decrees, namely presence of chemical/petrochemical plants, refineries, asbestos/other mineral fibers, steel plants, thermoelectric-power factories, mines/quarries, landfills/incinerators. Standardized mortality ratios, crude, and adjusted for deprivation (taking into account unemployment, education, house ownership, and overcrowding) were computed for 54 groups of causes of death (reference: regional populations, 1995–2002). Besides analyses of the health status, biomonitoring programs are in progress to improve exposure assessment and surveillance. Results: As an example, Taranto area, affected by a large industrial facility, including one of the largest European steel factories, showed significantly increased mortality for all causes, all cancers (namely esophagus, liver, pancreas, larynx, lung, and pleura), circulatory and respiratory diseases, and liver cirrhosis. Where applicable, cancer registry data are used to evaluate departures of observed incidence rates from expectation; thus, improving accuracy of outcome indicators and avoiding bias from differential survival by geographic area. In Taranto, an exploratory study on the body burden of dioxins and metals in a sample of residents is also ongoing. Conclusion: SENTIERI is the first project describing the health impact of residence in polluted sites at national level, it aims at identifying priorities in planning environmental remediation. International cooperation is desirable both for improving methodological approaches and for evaluating replicability of findings.