Cause specific mortality in an Italian pool of asbestos workers cohorts.

BACKGROUND: Asbestos is a known human carcinogen and is causally associated with malignant mesothelioma, lung, larynx and ovarian cancers. METHODS: Cancer risk was studied among a pool of formerly asbestos-exposed workers in Italy. Fifty-two Italian asbestos cohorts (asbestos-cement, rolling-stock, shipbuilding, and other) were pooled and their mortality follow-up was updated to 2018. Standardized mortality ratios (SMRs) were computed for major causes of death considering duration of exposure and time since first exposure (TSFE), using reference rates by region, age and calendar period. RESULTS: The study included 63,502 subjects (57,156 men and 6346 women): 40% who were alive, 58% who died (cause known for 92%), and 2% lost to follow-up. Mortality was increased for all causes (SMR: men = 1.04, 95% confidence interval [CI] 1.03-1.05; women = 1.15, 95% CI 1.11-1.18), all malignancies (SMR: men = 1.21, 95% CI 1.18-1.23; women = 1.29, 95% CI 1.22-1.37), pleural and peritoneal malignancies (men: SMR = 10.46, 95% CI 9.86-11.09 and 4.29, 95% CI 3.66-5.00; women: SMR = 27.13, 95% CI 23.29-31.42 and 7.51, 95% CI 5.52-9.98), lung (SMR: men = 1.28, 95% CI 1.24-1.32; women = 1.26, 95% CI 1.02-1.53), and ovarian cancer (SMR = 1.42, 95% CI 1.08-1.84). Pleural cancer mortality increased during the first 40 years of TSFE (latency), reaching a plateau thereafter. CONCLUSIONS: Analyses by time-dependent variables showed that the risk for pleural neoplasms increased with latency and no longer increases at long TSFE, consistent with with asbestos clearance from the lungs. Peritoneal neoplasm risk increased over all observation time.

Development and Validation of a Novel Pre-Pregnancy Score Predictive of Preterm Birth in Nulliparous Women Using Data from Italian Healthcare Utilization Databases.

Background: Preterm birth is a major worldwide public health concern, being the leading cause of infant mortality. Understanding of risk factors remains limited, and early identification of women at high risk of preterm birth is an open challenge. Objective: The aim of the study was to develop and validate a novel pre-pregnancy score for preterm delivery in nulliparous women using information from Italian healthcare utilization databases. Study Design: Twenty-six variables independently able to predict preterm delivery were selected, using a LASSO logistic regression, from a large number of features collected in the 4 years prior to conception, related to clinical history and socio-demographic characteristics of 126,839 nulliparous women from Lombardy region who gave birth between 2012 and 2017. A weight proportional to the coefficient estimated by the model was assigned to each of the selected variables, which contributed to the Preterm Birth Score. Discrimination and calibration of the Preterm Birth Score were assessed using an internal validation set (i.e., other 54,359 deliveries from Lombardy) and two external validation sets (i.e., 14,703 and 62,131 deliveries from Marche and Sicily, respectively). Results: The occurrence of preterm delivery increased with increasing the Preterm Birth Score value in all regions in the study. Almost ideal calibration plots were obtained for the internal validation set and Marche, while expected and observed probabilities differed slightly in Sicily for high Preterm Birth Score values. The area under the receiver operating characteristic curve was 60%, 61% and 56% for the internal validation set, Marche and Sicily, respectively. Conclusions: Despite the limited discriminatory power, the Preterm Birth Score is able to stratify women according to their risk of preterm birth, allowing the early identification of mothers who are more likely to have a preterm delivery.

Access to healthcare for undocumented migrants: analysis of avoidable hospital admissions in Sicily from 2003 to 2013.

Background: Access to healthcare services for undocumented migrants is one of the main public health issues currently being debated among European countries. Exclusion from primary healthcare services may lead to serious consequences for migrants' health. We analyzed the risk among undocumented migrants, in comparison with regular migrants, of being hospitalized for preventable conditions in the Region of Sicily (Italy). We performed a hospital-based cross-sectional study of the foreign population hospitalized in the Sicily region between 1 January 2003 and 31 December 2013. The first outcome was the proportion of avoidable hospitalization (AHs) among regular and irregular migrants. Second outcomes were the subcategories of AHs for chronic, acute and vaccine preventable diseases. 85 309 hospital admissions were analyzed. In the hospitalized population, in comparison to regular migrants, undocumented migrants show a higher proportion of hospitalization for diseases preventable through primary and preventive care (AOR1·48, 95%CI 1·37-1·59). The proportion of avoidable hospitalizations associated with the lack of legal status is higher for vaccine preventable conditions (AOR 2·06, 95%CI 1·66-2·56) than for chronic conditions (AOR 1·47, 95%CI 1·42-1·63) and acute conditions (AOR 1·37; 95%CI 1·23-1·53). Between 2003 and 2013, the proportion of avoidable hospitalizations decreased both in regular and undocumented migrants but decreased faster for regular than for undocumented migrants. Undocumented migrants experience higher proportion of hospitalization for preventable conditions in comparison with regular migrants probably due to a lack of access to the national healthcare service. Policies and strategies to involve them in primary healthcare and preventive services should be developed to tackle this inequality.

Mortality and morbidity study of petrochemical employees in a polluted site.

BACKGROUND: The area of Gela was included among the 57 Italian polluted sites of national interest for environmental remediation because of its widespread contamination from a petrochemical complex. The present study investigates mortality and morbidity of the cohort of Gela petrochemical workers with the aim of disentangling occupational from residential risk. METHODS: Mortality was assessed for 5,627 men hired from 1960, year of the plant start-up, to 1993; it was followed up for vital status in the period 1960-2002. Morbidity was analysed for 5,431 workers neither dead nor lost to follow-up from 1960 to 2001 and was based on Hospital Discharge Records in the period 2001-2006. The work experience was classified in terms of job categories such as blue collars, white collars, and both--workers who shifted from blue to white collar (95%) or vice versa. An ad hoc mobility model was applied to define qualitative categories of residence in Gela, as residents and commuters. Standardized Mortality Ratios (SMRs) and Mortality Rate Ratios (MRRs) were computed, the latter by using a Poisson regression model. Morbidity was analyzed in terms of Hospital Discharge Odds Ratios (HDORs) through a logistic regression model. While performing the internal comparisons, white collars was the reference category for the job analysis, and commuters was the reference category for the residential analysis. RESULTS: In the light of epidemiological evidence about health risk from petrochemical industries in both occupational and environmental settings, and/or on the basis of information about occupational and residential contamination and health risk in the area of Gela, noteworthy results are shown for lung cancer [MRR: 2.11 (CI 90%; 0.96-4.63) in blue collars; 1.71 (1.09-2.69) in residents], respiratory diseases [HDOR: 2.0 (1.0-3.0) in blue collars; 1.4 (0.96-2.06) in residents] and genitourinary diseases [HDOR: 1.34 (1.06-1.68) in blue collars; 1.23 (1.04-1.45) in residents]. CONCLUSIONS: The results support a role of the exposures in the occupational and residential settings, the latter due to the local ascertained contamination, in affecting the workers' health. These results underline the urgent need of water, soil, air and food-chain monitoring programs, to discover active sources of exposure and consequently define public health interventions.

[Mortality and hospital discharges in the population of Biancavilla (Sicily) contaminated by natural fibres]. / Mortalità e ricoveri ospedalieri nella popolazione di Biancavilla (CT) con esposizione cronica a fibre naturali.

OBJECTIVE: The volcanic area of Biancavilla (Sicily Italy) has been included by the Italian national law among the areas of "environmental reclamation" due to the presence of amphibole fluoro-edenitic fibres in the environment. The aim of the study was to evaluate the health of residents in the area, through the analysis of the mortality registry and the hospital discharge records. DESIGN: Age, cause and gender specific indirect standardized mortality ratios SMR (1995-2000) and morbidity ratios SHR (2001-2003) were computed with 95% confidence intervals, using the population of surrounding municipalities as reference. RESULTS: statistically significant increases in mortality and morbidity were observed, both in men and women, for malignant pleural neoplasms (mortality: men SMR= 700, 6 observed; women SMR= 840, 3 observed; hospital admissions: women SHR= 1210, 5 observed), cardiovascular diseases (mortality: men SMR= 115, 267 observed, women SMR= 115, 278 observed; hospital admissions: men SHR= 109, 631 observed; women SHR= 114, 528 observed) and respiratory diseases (mortality: men SMR= 164, 68 observed; women: SMR= 215, 44 observed; hospital admissions: men SHR= 139, 558 observed, women SHR= 125, 374 observed). CONCLUSIONS: the excesses observed in this study are consistent with previous findings and suggest the need for further investigations aimed at improving the knowledge of the mineralogical aspects of the fibres, the assessment of human exposure and at estimating the prevalence of pleural plaques and lung fibrosis.

[Mortality (1995-2000) and hospital admissions (2001-2003) in the industrial area of Gela]. / Analisi della mortalità (1995-2000) e dei ricoveri ospedalieri (2001-2003) nell'area industriale di Gela.

AIMS: the area of Gela (Sicily Italy) has been included by the Italian national law among the "areas of environmental concern", due to several industrial plants located in the area: a refinery, a petrolchemical plant and an industrial waste disposal. The aim of the study was to evaluate the health of residents in the area, through the analysis of the mortality registry and the hospital discharge records. DESIGN: cause and gender specific indirect Standardized Mortality (1995-2000) and Morbidity (2001-2003) Ratios were computed, with 95% confidence intervals, using the population of surrounding municipalities as reference. RESULTS: increases of malignant neoplasm of stomach, colon rectum, larynx, lung, bladder and non Hodgkin lymphoma were observed in the area, both in men and women. Moreover, an increased frequency of hospital admissions for cardiovascular diseases and for respiratory diseases (acute and chronic diseases, asthma both among adults and among children) were observed. Excesses of pneumoconiosis among men and of renal diseases among women were also present. CONCLUSION: the excesses in mortality and morbidity observed in this study are consistent with previous findings and might partly be explained by occupational exposures. However, the excesses found among women suggest a possible role of environmental pollutants.