Occupational carcinogens in Italy: an overview on exposure to cadmium and its compounds.

Given the recognized carcinogenicity of cadmium, several regulatory interventions have been carried out over the years to protect exposed workers. The aim of the study is to investigate the prevalence and extent of exposure to cadmium among Italian workers. Data was collected from a nation-wide occupational exposure registry (SIREP, 1996-2022). Gender-specific statistical analysis was carried out for some exposure-related variables (cadmium compound, activity sector, occupational group, firm size). Potentially exposed workers were estimated for some industrial sectors. Concurrent exposures were investigated using cluster analysis. Overall 4,264 measurements were analyzed. Four industrial sectors were found to be most involved by cadmium exposure: base metal manufacturing, fabricated metal products, machinery and equipment, and other transport equipment (55% of measurements). Jewellery/precious-metal workers, and glass/ceramic plant operators were found to be most at exposure risk. A total of 26,470 workers potentially exposed was estimated (69% men). Concurrent exposures to other occupational carcinogens were detected quite frequently (52% of workers). Several situations of exposure and co-exposure to cadmium deserve attention and awareness in order to minimize the risks associated with workers' health. Recognition of potentially hazardous exposure conditions is an important step in prevention strategies to better protect workers against cancer-causing agents.

Incidence of mesothelioma in young people and causal exposure to asbestos in the Italian national mesothelioma registry (ReNaM).

INTRODUCTION: The epidemiological surveillance of mesothelioma incidence is a crucial key for investigating the occupational and environmental sources of asbestos exposure. The median age at diagnosis is generally high, according to the long latency of the disease. The purposes of this study are to analyse the incidence of mesothelioma in young people and to evaluate the modalities of asbestos exposure. METHODS: Incident malignant mesothelioma (MM) cases in the period 1993-2018 were retrieved from Italian national mesothelioma registry and analysed for gender, incidence period, morphology and exposure. Age-standardised rates have been calculated and the multiple correspondence analysis has been performed. The association between age and asbestos exposure has been tested by χ2 test. RESULTS: From 1993 to 2018, 30 828 incident MM cases have been collected and 1278 (4.1%) presented diagnosis at early age (≤50 years). There is a substantial association between age at diagnosis and the type of asbestos exposure and a significantly lower frequency of cases with occupational exposure to asbestos (497 cases vs 701 expected) in young people has been documented. Paraoccupational and environmental exposure to asbestos have been found more frequent in young MM cases (85 and 93 observed cases vs 52 and 44 expected cases, respectively). CONCLUSIONS: Mesothelioma incidence surveillance at population level and the anamnestic individual research of asbestos exposure is a fundamental tool for monitoring asbestos exposure health effects, supporting the exposure risks prevention policies. Clusters of mesothelioma incident cases in young people are a significant signal of a potential non-occupational exposure to asbestos.

Benzene and cause-specific mortality in an Italian national cohort of exposed workers through a proportions analysis.

BACKGROUND: occupational exposure to benzene represents a threat for the health of a still relevant number of workers. An increased risk of leukaemias has been demonstrated among exposed workers, while a weaker association has been found for other malignancies. OBJECTIVES: to evaluate mortality risk among workers exposed to benzene across economic sectors in Italy. DESIGN: proportionate mortality ratios (PMRs) were calculated linking exposure occupational information to national mortality statistics (2005-2018), assuming a Poisson distribution of the data. SETTING AND PARTICIPANTS: data from the Italian national registry on occupational exposure to carcinogens (SIREP) in the period 1996-2018 were selected. MAIN OUTCOMES MEASURES: PMRs by cause of death were reported. Specific analyses by cancer site and activity sector, profession, and cumulative exposure were performed. RESULTS: a total of 858 deaths (97% in men) were identified among 38,704 exposed workers (91% men). An excess of deaths from malignant neoplasm of the lung was found among exposed workers, in both genders (PMR 1.27 in men; PMR 3.00 in women). An increased proportion of deaths was also found from leukaemias (leukaemia of unspecified cell type: PMR in men 2.99; 95%CI 1.24-7.19), and multiple myeloma in the chemical industry (PMR in men 2.27; 95%CI 1.08-4.76). CONCLUSIONS: the risk of leukaemia in the petrochemical industry has been confirmed, while an excess risk of lung cancer mortality was highlighted in the retail sale of automotive fuels. Epidemiological surveillance and air and biological monitoring are recommended for workers exposed to benzene to ensure compliance with regulatory requirements and reduce exposure-related deaths.

Assessment of Occupational Carcinogenic Risk by Comparing Data from the Italian Register of Occupational Exposures to Carcinogens (SIREP) with the International Agency for Research on Cancer (IARC) Evidence.

In Italy, the National Register on Occupational Exposure to Carcinogens (SIREP) is established pursuant to article 243 of Legislative Decree 81/2008 and is aimed to collect information on the exposure of workers to carcinogens transmitted by employers. The aim of this study is to assess its level of implementation comparing prevailing carcinogens reported in SIREP with the monitoring of risks in the workplace evidenced by the International Agency for Research on Cancer (IARC). The data reported in the SIREP have been integrated with IARC and the database on carcinogenic risk in the workplace named MATline in order to build a matrix containing the carcinogens classified according to the IARC (Group 1 and 2A agents) and to a semi-quantitative indicator of risk level (High or Low) calculated upon the number of exposures reported in SIREP. The matrix contains the following data: carcinogens, economic sector (NACE Rev2 coding) and cancer sites. The comparison between SIREP and IARC evidence allowed us to highlight situations with a high risk of carcinogenicity and to address appropriate actions of prevention to contain the risks of exposure to carcinogenic substances.

Occupational exposure register-based cohort study on mortality among asbestos-related workers in Italy after the ban.

OBJECTIVE: Asbestos is a human carcinogen and can cause some types of cancer, including mesothelioma. A relevant number of workers are still engaged in asbestos removal and disposal activities, whose actual risk of asbestos-related diseases is still scarcely recognized. The main objective of this study is to assess the cause-specific mortality among workers involved in asbestos removal and disposal after the ban in Italy. METHODS: Data from the Information System on Occupational Exposure to carcinogens (SIREP) in the period 1996-2018 were selected. Proportionate mortality ratios (PMRs) by cause of death were calculated by linking exposure occupational information to national mortality statistics (2005-2018), assuming a Poisson distribution of the data. RESULTS: A total of 142 deaths (all men) were identified among 13 715 asbestos removal and disposal workers. A significant excess ( P < 0.05) of mesothelioma deaths was found among male workers, about five-fold the expected. A significant increase in the mortality ratio was also found for malignant melanoma of skin. CONCLUSIONS: A risk of mesothelioma has been found among workers involved in asbestos removal and disposal. Epidemiological surveillance and promotion of prevention action plans are highly recommended for workers engaged in asbestos removal and disposal activities, to ensure compliance with regulatory requirements and reduce the still relevant risk of contracting the related tumor pathology.

An occupational health risk index: definition, description and mapping at municipality level.

OBJECTIVES: to develop an occupational health risk index that can help to introduce the occupational risk component into epidemiological studies and assess the level of occupational risk in Italian municipalities useful for supporting prevention measures. DESIGN: defi nition of a municipal index as a combination of occupational and territorial indicators derived from national registers of occupational data and environmental archives. SETTING AND PARTICIPANTS: the index composition is based on data on work injuries, occupational diseases and workers exposed to carcinogens in the years 2015-2019 available at the municipal level, as well as data on municipalities hosting sites of national interest for environmental remediation (SIN) and those in which big industrial facilities (GIE), registered as pollutant emitters, are located. MAIN OUTCOME MEASURES: standardized rates of occupational injuries and occupational diseases occurred in Italian municipalities were calculated from data collected by the Italian National Institute for Insurance against Accidents at Work (Inail) in relation to the working-age population (15-69 and 15+ for injuries and occupational diseases, respectively), estimated by the Italian National Statistical Institute (Istat) in 2018. In addition, data from the National Information System on Occupational Exposure to carcinogens (SIREP) were included, from which raw rates were calculated at municipal level. Finally, two other indicators were included, describing the presence/absence of a SIN and the number of GIEs industrial facilities in each municipality. The index of occupational health risk (INDORS) is calculated by summing standardised values of the above fi ve indicators as a continuous variable and it was also classifi ed by quintiles of population as a categorical variable. The association between cause-specific mortality and INDORS levels was evaluated using data on mortality occurring in 2015. RESULTS: during the observation period 2,011,457, 131,353 and 140,183 events were recorded for injuries, occupational diseases and workers exposed to carcinogens, mainly among male workers. A municipal map of INDORS levels (1-5) shows a strong South-North gradient, in line with the Italian industrial geographical context. The contributions of the SIN and GIE indicators are higher in the hot spot municipalities located in the Southern regions and islands. Among the municipalities analysed 1,099 were classifi ed in the lowest risk level, 1,331 in the low-medium level, 1,619 in the medium level, 2,621 in the medium-high level and 1,284 in the highest risk level. The index shows a direct correlation with accidental mortality and an inverse correlation with all-cause and malignant neoplasm mortality. CONCLUSIONS: the proposed index can be useful to introduce the occupational risk dimension in ecological studies and results as a flexible tool to rank Italian municipalities in terms of occupational risk.

Proportionate mortality among workers exposed to hardwood dust in Italy.

AIMS: The main aim of this study is to estimate the impact on workers' health caused by hardwood dust exposure in selected industrial sectors in Italy. METHODS: Proportionate mortality ratios (PMR) by cancer site were calculated by linking the information on occupational exposure to carcinogens from the Italian national registry (SIREP, 1996-2018) to the national mortality archives (ISTAT, 2005-2018), assuming a Poisson distribution of the data. RESULTS: An elevated proportion of deaths from sino-nasal cancer was found in male exposed workers (PMR=4.25, CI 95%=1.37-13.23). Increased proportions of deaths were also found from stomach cancer in both genders (PMR=3.14, CI 95%=1.41-7.00 women; PMR=1.64, CI 95%=1.22-2.19 men). CONCLUSIONS: Although hardwood dust is a known human carcinogen, there are still many high-risk occupational exposure settings. Epidemiological surveillance and continuous monitoring of workers is highly recommended in order to ensure compliance with regulatory obligations and limit the burden of associated mortality causes.

The impact of vinyl chloride exposure on the health of Italian workers: an evaluation from SIREP compliance data.

The aim of the study is to investigate exposures to vinyl chloride monomer (VCM) at workplace in Italy and the related burden of diseases. Measurements data was collected from a nation-wide occupational exposure registry (SIREP, 1996-2016). Potentially exposed workers were estimated for some industrial sectors. Concurrent exposures were investigated using cluster analysis. Proportionate mortality ratios were calculated linking data to national mortality statistics (2005-2015). Overall 8,460 measurements were analyzed. Most exposures occurred in the manufacture of chemicals and plastic products. A total of 12,148 workers potentially exposed was estimated (64% male). Concurrent exposures were detected frequently (83%). An elevated proportion of deaths for liver cancer was found in male exposed workers. Although VCM is a known carcinogen for humans, there are still many exposure situations, albeit at low doses, in the chemical and plastic industries.

Occupational impact in COVID-19 pandemic according to one year of compensation claims in Italy.

OBJECTIVES: to evaluate the patterns of occupational COVID-19 cases, based on compensation claims applied to the Italian National Institute for Insurance against Accidents at Work (Inail). DESIGN: descriptive analyses of daily time series of compensation claims applications, geographical distributions, and occupations involved. Multivariate analyses have been performed for identifying significant epidemiological pattern. SETTING AND PARTICIPANTS: compensation claims for COVID-19 injuries received by Inail from March 2020 to February 2021 have been analysed. MAIN OUTCOME MEASURES: daily time series of compensation claims applications in the first year of pandemic and comparatively with population data, patterns of occupations majorly involved in time, territorial clusters. RESULTS: in the observed period, Inail has received 155,684 workers' compensation claims with a first peak (more than 1,000 daily compensation claims) in March 2020 and a second peak (more than 1,500) in November 2020. A time dependent geographical pattern was identified, with the Northern regions formerly affected in the first phase, followed by a diffusion in the Central and Southern regions during the summer period. Health technicians (32% and 42% in male and female, respectively) and physicians (15%and 6%) were the most involved workers. The timing of infection was found to depend by job, with physicians, nurses, and health technicians firstly involved with a spread of about 2 weeks with respect to other jobs. Trend in health workers' vaccination has been found in a clear inverse relationship with the decreasing number of compensation claims, remaining, since February 2021, under one hundred daily cases of occupational COVID-19 compensation claims. CONCLUSIONS: different intensities, timing, and characteristics were found among application claims, which address for different pandemic diffusion paths. Health workers are the firstly and most involved impacted by the pandemic. The use of application claims could be useful and effective in monitoring the occupational component of COVID-19 and his trend in time and space. There is a need to establish an epidemiological surveillance system that includes the assessment of work related risk, supporting the effectiveness of public insurance and welfare system, and to harmonize occupational data collection among countries.

Asbestos Exposure and Malignant Mesothelioma in Construction Workers-Epidemiological Remarks by the Italian National Mesothelioma Registry (ReNaM).

Notwithstanding the ban in 1992, asbestos exposure for workers in the construction sector in Italy remains a concern. The purpose of this study is to describe the characteristics of malignant mesothelioma (MM) cases recorded by the Italian registry (ReNaM) among construction workers. Incident mesothelioma cases with a definite asbestos exposure have been analyzed. Characteristics of cases and territorial clusters of crude rates of MM in construction workers have been described, as well as the relation between asbestos use before the ban and the historical trend of workforce in the construction sector in Italy. ReNaM has collected 31,572 incident MM cases in the period from 1993 to 2018 and asbestos exposure has been assessed for 24,864 (78.2%) cases. An occupational exposure has been reported for 17,191 MM cases (69.1% of subjects with a definite asbestos exposure). Among them, 3574 had worked in the construction sector, with an increasing trend from 15.8% in the 1993-98 period to 23.9% in 2014-2018 and a ubiquitous territorial distribution. The large use of asbestos in construction sector before the ban makes probability of exposure for workers a real concern still today, particularly for those working in maintenance and removal of old buildings. There is a clear need to assess, inform, and prevent asbestos exposure in this sector.

Occupational asbestos exposure after the ban: a job exposure matrix developed in Italy.

BACKGROUND: Asbestos is a well-known carcinogen for humans. The aim of this study is to develop a tool to estimate occupational asbestos exposure in Italy after the ban using information collected in a national dataset. METHODS: Data were collected from firm registries of workers exposed to asbestos in the period 1996-2016. Descriptive statistics (arithmetic mean, standard deviation, geometric mean and geometric standard deviation) were calculated for the main exposure-related variables (activity sector, occupational group and exposure period). An estimate of workers potentially exposed to asbestos was also performed. RESULTS: A total of 19 704 airborne measurements of asbestos exposure was selected from the national database of occupational exposures in the sectors of asbestos abatement. Overall, a geometric mean of 7.93 f l-1 was found, and chrysotile was the asbestos type that had more exposures (41%). A total of 46 422 workers was estimated to be potentially at asbestos exposure risk. Exposure data were summarized by calendar period, activity sector and occupational group. CONCLUSIONS: The construction of a job exposure matrix for different occupation/industry combinations may allow the assessment of occupational exposure to asbestos in several removal and disposal activities, and the estimate of the risks associated with asbestos-related diseases in epidemiological studies.

Assessment of exposure to cobalt and its compounds in Italian industrial settings.

BACKGROUND: Adverse health effects of occupational exposure to cobalt and its compounds are well-documented. OBJECTIVES: The aim of the study is to evaluate exposures to cobalt in Italian industrial settings. METHODS: Data on cobalt and its compounds were collected from an occupational exposure registry. Statistical analysis was carried out for some exposure-related variables (i.e., cobalt compound, activity sector, occupational group, firm size). The number of workers potentially exposed was estimated for selected industrial sectors. RESULTS: Overall 1,701 measurements were analyzed in the period 1996-2016. The geometric mean of cobalt airborne concentration was 0.33 µg/m3. Most exposures occurred in the manufacture of fabricated metal products (50%) and among metal finishing-, plating- and coating-machine operators (42%). A total of 30,401 workers potentially exposed to cobalt was estimated, over 72% were male. CONCLUSIONS: Identifying professional groups at high-risk of exposure can help to control the most dangerous situations for workers' health. Surveillance systems based on occupational exposure registries contribute to support systematic improvement of working conditions.

Evaluating Antineoplastic Agents and Occupational Exposures Among Italian Workers Using SIREP Surveillance System.

OBJECTIVE: The aim of the study is to evaluate exposures to antineoplastic agents at workplaces in healthcare and manufacturing in Italy. METHODS: Data on antineoplastic agents were collected from occupational exposure registries. Statistical analysis was carried out for exposure-related variables. The number of workers potentially exposed was estimated for selected industrial sectors. Concurrent exposures were investigated using cluster analysis. RESULTS: Overall 15,763 exposure situations were analyzed during 1996 to 2016. Most exposures occurred in healthcare (66%). A total of 11,830 workers potentially exposed to antineoplastic agents was estimated. Concurrent exposures were frequently detected in the pharmaceutical industry and among healthcare workers. CONCLUSIONS: Occupational exposure to antineoplastic agents currently represents a matter of concern both in the chemical industry and in the healthcare sector. The growing number of agents in use supports the need to constantly control exposures.

Nickel compounds in the workplaces: Occupations and activities involving high-risk exposures in Italy.

BACKGROUND: Nickel (Ni) compounds have been classified as carcinogenic to humans. The aim of the study is to evaluate exposures to Ni at workplaces in Italy. METHODS: Data on Ni compounds were collected from an occupational exposure registry. Statistical analysis was carried out for exposure-related variables. The number of workers potentially exposed was estimated for selected industrial sectors. Concurrent exposures with other occupational carcinogens were investigated using two-step cluster analysis. RESULTS: Overall 10 083 measurements were analyzed during 1996-2016, having a geometric mean of 2.93 µg/m3 . Most exposures occurred in manufacture of metal products (50%) and among metal finishing machine operators (46%). A total of 56 046 workers potentially exposed to Ni was estimated. Concurrent exposures were frequently detected, mainly with chromium VI and cobalt compounds. CONCLUSIONS: Systematic recording of occupational exposures provides a data source that allows recognition of high risk situations for workers' health and helps improve exposure assessment in epidemiologic studies.

Gender differences in occupational exposure to carcinogens among Italian workers.

BACKGROUND: Many carcinogenic chemicals are still used or produced in several economic sectors. The aim of this study is to investigate differences in occupational exposure patterns to carcinogens by gender in Italy. METHODS: Information about the most common carcinogens recorded in the Italian occupational exposures database (SIREP) for the period 1996-2015 was retrieved. Descriptive statistics were calculated for exposure-related variables (carcinogenic agent, occupational group, economic activity sector, and workforce size). The chi-square(χ2) test was used to verify differences between genders, and logistic regression analysis was performed to evaluate the association between gender and risk of having higher exposure levels, after adjusting for age. Concurrent exposures to multiple carcinogens were investigated using the two-step cluster analysis. RESULTS: A total of 166,617 exposure measurements were selected for 40 different carcinogens. Exposed workers were only in a small proportion women (9%), and mostly aged 20-44 years (70%) in both genders. Women were more likely to be exposed than men to higher levels for several carcinogens even after correction for age at exposure, and the exposure level was significantly (p < 0.01) associated with occupation, economic sector and workforce size. The five main clusters of co-exposures identified in the entire dataset showed a differential distribution across economic sectors between genders. CONCLUSIONS: The exposures to occupational carcinogens have distinguishing characteristics in women, that are explained in part by work and job segregation. Because of the presence of high-exposed groups of female workers in many industrial sectors, further research and prevention efforts are recommended.

Epidemiology of malignant mesothelioma in Italy: surveillance systems, territorial clusters and occupations involved.

BACKGROUND: As a legacy of the large asbestos consumption until the definitive ban in 1992, Italy is currently suffering a severe epidemic of asbestos related diseases. The aim of this paper is to describe the surveillance system for mesothelioma incidence and to provide evidences regarding the occurrence of the disease in Italy and the circumstances of asbestos exposure. METHODS: Italian National Register of Malignant Mesotheliomas (ReNaM) is a permanent surveillance system of mesothelioma incidence, with Regional Operating Centres (CORs) active in each Italian region, identifying incident malignant mesothelioma (MM) cases from health care structures. Occupational history, lifestyle habits and residential history are obtained using a standardised questionnaire, administered by a trained interviewer, to the subject or to the next of kin. Descriptive epidemiological figures, occupations involved in exposures and territorial maps of MM cases have been produced. RESULTS: At December 2016, ReNaM has collected 27,356 MM cases for the incidence period between 1993 and 2015. The modalities of exposure to asbestos have been investigated for 21,387 (78%) and an occupational exposure has been defined for around 70% of interviewed cases (14,818). Non-occupational exposure is still relevant with 4.9% and 4.4% of cases for which respectively a familial exposure (due to the cohabitation with an occupational exposed subject) and an environmental exposure (due to the residence near a contaminated site) has been detected. DISCUSSION: The epidemiological surveillance of MM incident cases, by the means of a national register for estimating the occurrence of the disease and identifying the circumstances of asbestos exposure, is a relevant tool for preventing asbestos exposure, for supporting the effectiveness of insurance system and for estimating reliable epidemiological figures.

The epidemiology of malignant mesothelioma in women: gender differences and modalities of asbestos exposure.

INTRODUCTION: The epidemiology of gender differences for mesothelioma incidence has been rarely discussed in national case lists. In Italy an epidemiological surveillance system (ReNaM) is working by the means of a national register. METHODS: Incident malignant mesothelioma (MM) cases in the period 1993 to 2012 were retrieved from ReNaM. Gender ratio by age class, period of diagnosis, diagnostic certainty, morphology and modalities of asbestos exposure has been analysed using exact tests for proportion. Economic activity sectors, jobs and territorial distribution of mesothelioma cases in women have been described and discussed. To perform international comparative analyses, the gender ratio of mesothelioma deaths was calculated by country from the WHO database and the correlation with the mortality rates estimated. RESULTS: In the period of study a case list of 21 463 MMs has been registered and the modalities of asbestos exposure have been investigated for 16 458 (76.7%) of them. The gender ratio (F/M) was 0.38 and 0.70 (0.14 and 0.30 for occupationally exposed subjects only) for pleural and peritoneal cases respectively. Occupational exposures for female MM cases occurred in the chemical and plastic industry, and mainly in the non-asbestos textile sector. Gender ratio proved to be inversely correlated with mortality rate among countries. CONCLUSIONS: The consistent proportion of mesothelioma cases in women in Italy is mainly due to the relevant role of non-occupational asbestos exposures and the historical presence of the female workforce in several industrial settings. Enhancing the awareness of mesothelioma aetiology in women could support the effectiveness of welfare system and prevention policies.

Appraisal of levels and patterns of occupational exposure to 1,3-butadiene.

Objectives 1,3-butadiene is classified as carcinogenic to human by inhalation and the association with leukemia has been observed in several epidemiological studies. The aim of this study was to evaluate data about occupational exposure levels to 1,3-butadiene in the Italian working force. Methods Airborne concentrations of 1,3-butadiene were extracted from the Italian database on occupational exposure to carcinogens in the period 1996-2015. Descriptive statistics were calculated for exposure-related variables. An analysis through linear mixed model was performed to determine factors influencing the exposure level. The probability of exceeding the exposure limit was predicted using a mixed-effects logistic model. Concurrent exposures with other occupational carcinogens were investigated using the two-step cluster analysis. Results The total number of exposure measurements selected was 23 885, with an overall arithmetic mean of 0.12 mg/m3. The economic sector with the highest number of measurements was manufacturing of chemicals (18 744). The most predictive variables of the exposure level resulted to be the occupational group and its interaction with the measurement year. The highest likelihood of exceeding the exposure limit was found in the manufacture of coke and refined petroleum products. Concurrent exposures were frequently detected, mainly with benzene, acrylonitrile and ethylene dichloride, and three main clusters were identified. Conclusions Exposure to 1,3-butadiene occurs in a wide variety of activity sectors and occupational groups. The use of several statistical analysis methods applied to occupational exposure databases can help to identify exposure situations at high risk for workers' health and better target preventive interventions and research projects.

National Estimates of Exposure to Formaldehyde in Italian Workplaces.

Purpose: Formaldehyde is classified as human carcinogen and the association with nasopharyngeal cancer has been observed in many epidemiological studies. The aim of this study is to evaluate data about occupational exposure levels to formaldehyde in the Italian working force. Methods: Airborne concentrations of formaldehyde were extracted from the Italian database on occupational exposure to carcinogens and refer to the period 1996-2014. Descriptive statistics were calculated for exposure-related variables. The number of workers potentially exposed was estimated for the activity sectors better characterized in the database. An analysis through linear mixed models was performed to determine factors influencing the exposure level. Results: A total of 1610 formaldehyde exposure measurements were selected from the database, having an overall arithmetic mean of 0.12 mg m-3 and a geometric mean of 0.04 mg m-3. The activity sectors with the highest number of measurements were the manufacturing of chemicals and chemicals products (N = 529) in men and the health and social work in women (N = 105). The number of workers potentially exposed in the selected sectors was 49450, and the most predictive independent variables of the exposure level resulted to be the occupational group and the year of measurement. Conclusions: The occupational exposure to formaldehyde occurs in a variety of different sectors, but currently workers at higher risk are those employed in the healthcare sector and in the wood processing industry. Prevention measures have to be targeted to reduce the risk to workers' health, also in a gender perspective. This study confirms the important role of occupational exposure databases as a valuable source of data for the epidemiological assessment of risks in workplaces.