Factors Affecting Asbestosis Mortality Among Asbestos-Cement Workers in Italy.

OBJECTIVES: This study was performed with the aim of investigating the temporal patterns and determinants associated with mortality from asbestosis among 21 cohorts of Asbestos-Cement (AC) workers who were heavily exposed to asbestos fibres. METHODS: Mortality for asbestosis was analysed for a cohort of 13 076 Italian AC workers (18.1% women). Individual cumulative asbestos exposure index was calculated by factory and period of work weighting by the different composition of asbestos used (crocidolite, amosite, and chrysotile). Two different approaches to analysis, based on Standardized Mortality Ratios (SMRs) and Age-Period-Cohort (APC) models were applied. RESULTS: Among the considered AC facilities, asbestos exposure was extremely high until the end of the 1970s and, due to the long latency, a peak of asbestosis mortality was observed after the 1990s. Mortality for asbestosis reached extremely high SMR values [SMR: males 508, 95% confidence interval (CI): 446-563; females 1027, 95% CI: 771-1336]. SMR increased steeply with the increasing values of cumulative asbestos exposure and with Time Since the First Exposure. APC analysis reported a clear age effect with a mortality peak at 75-80 years; the mortality for asbestosis increased in the last three quintiles of the cumulative exposure; calendar period did not have a significant temporal component while the cohort effect disappeared if we included in the model the cumulative exposure to asbestos. CONCLUSIONS: Among heaviest exposed workers, mortality risk for asbestosis began to increase before 50 years of age. Mortality for asbestosis was mainly determined by cumulative exposure to asbestos.

[Mortality study in a cohort of workers employed in the hot working processing of plastics and rubber]. / Studio di mortalità in una coorte di esposti nella lavorazione a caldo di materie plastiche e gomma.

OBJECTIVES: to study mortality rates among workers in companies manufacturing thermoplastic and rubber articles (excluding tyres). DESIGN: cohort study. SETTING AND PARTICIPANTS: the cohort includes 4,543 workers employed up to 2000 in 131 companies in the Province of Bologna (Emilia-Romagna Region, Northern Italy) exposed to emissions from hot processing of plastics (3,937) and rubber (606). MAIN OUTCOME MEASURES: general- and cause-specific Standardized Mortality Rates (SMR), with 95% confidence intervals; entire reference population resides in the Emilia-Romagna Region. RESULTS: excess mortality for all causes (116 Obs; SMR: 1.20; 95%CI 1.00-1.44) and for lung cancer (18 Obs; SMR: 1.67; 95%CI 1.05-2.65) in men of the rubber factories. Increased mortality rates for oesophageal cancers in women (3 Obs; SMR: 5.41; 95%CI 1.74-16.8) and in men (6 Obs; SMR: 2.16; 95%CI 0.97-4.81), for malignant tumours of pancreas (16 Obs; SMR: 1.65; 95%CI 1.01- 2.70), rectum (11 Obs; SMR: 2.17; 95%CI 1.20-3.92) and kidney (11 Obs; SMR: 1.98; 95%CI 1.10-3.58) in men occupied in plastic processing. CONCLUSION: in this study, we observed an excess of mortality rates for lung cancer in men of rubber factories and for malignant tumours of the digestive tract, pancreas, and kidney in workers employed in the production of plastic articles. Nevertheless, these results must be interpreted with caution, because exposures to non-occupational risk factors, like tobacco smoke or other occupational exposures outside the companies concerned, are not known. The results suggest to continue epidemiological surveillance.

[Determinants of occupational injuries in the construction of the "high speed train" Bologna-Florence]. / I determinanti degli infortuni sul lavoro nella costruzione della linea ferroviaria "treno ad alta velocità" Bologna-Firenze.

OBJECTIVE: to study determinants of occupational injuries in tunnel construction using data from the surveillance system which had been implemented in order to monitor accidents during the construction of the "high speed train tracks in the Italian Regions Emilia-Romagna and Tuscany. DESIGN: retrospective cohort study. SETTING: 16 sites for the construction of 14 tunnels of the high speed railway-tract Bologna-Firenze, in Italy. PARTICIPANTS: 1,602 workers (of 3,000 employed in the underground tunnelling), aged 18 - 67 years, operating during excavation with traditional method in 1999-2002. A total of 549 injuries occurred among 385 workers. The number of worked hours were used as time at risk. MAIN OUTCOME MEASURES: incidence rate ratios (IRR) and 95% confidence intervals for all injuries, serious injuries and first injuries were considered in separate multiple regression analyses (Poisson). RESULTS: residence, task and working phase were taken into consideration. An increased risk was found for younger workers, for carpenters (IRR "all-events" = 2.33; 95% CI=1.85-2.94; IRR" first-events" = 2.12; 95% CI 1.62-2.77) and miners (IRR "all-events" = 1.76; 95% CI 1.39-2.24; IRR"first-events" = 1.71; 95% CI 1.30-2.24) vs. machinery operators. Construction of inverted arch turns out to have an incidence rate ratio three times higher than digging out (IRR "all-events" = 2.79; 95% CI 2.27-3.43; IRR "firsts-event = 2.98; 95% CI 2.33-3.81). The probability of "serious" injuries (>30 days) is higher for miners (IRR=2.45; 95% CI 1.65-3.64) and for carpenters (IRR=2.31; 95% CI 1.53-3.49). CONCLUSION: this study pointed out to indicate some determinants (age, task and work phase) of injuries in tunneling about which little had been published previously. These results are useful for addressing preventive measures, for control and prevention activities and point to the need to explore the effect of experience and to study, through a case crossover design, transient working and individual risk factors for traumatic injury within these working sites.