Elsevier

Environmental Research

Volume 188, September 2020, 109691
Environmental Research

Estimate of environmental and occupational components in the spatial distribution of malignant mesothelioma incidence in Lombardy (Italy)

https://doi.org/10.1016/j.envres.2020.109691Get rights and content
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Highlights

  • Malignant Mesothelioma (MM) occurrence is partially explained by occupational exposure to asbestos, particularly in women.

  • Many sources of non-occupational asbestos exposure are yet to be discovered.

  • The geographical pattern of incidence at municipality level was studied using data from Lombardy Mesothelioma Register.

  • A shared Bayesian model was used to disentangle occupational and environmental components in the spatial pattern of MM.

  • Evidence was found of two main routes of non-occupational exposure: industries and geological features of the Alpine area.

Abstract

Introduction

Measuring and mapping the occurrence of malignant mesothelioma (MM) is a useful means to monitor the impact of past asbestos exposure and possibly identify previously unknown sources of asbestos exposure.

Objective

Our goal is to decompose the observed spatial pattern of incidence of MM in the Lombardy region (Italy) in gender-specific components linked to occupational exposure and a shared component linked to environmental exposure.

Materials and methods

We selected from the Lombardy Region Mesothelioma Registry (RML) all incident cases of MM (pleura, peritoneum, pericardium, and tunica vaginalis testis) with first diagnosis in the period 2000–2016. We mapped at municipality level crude incidence rates and smoothed rates using the Besag York and Mollié model separately for men and women. We then decomposed the spatial pattern of MM in gender-specific occupational components and a shared environmental component using a multivariate hierarchical Bayesian model.

Results

We globally analyzed 6226 MM cases, 4048 (2897 classified as occupational asbestos exposure at interview) in men and 2178 (780 classified as occupational asbestos exposure at interview) in women. The geographical analysis showed a strong spatial pattern in the distribution of incidence rates in both genders. The multivariate hierarchical Bayesian model decomposed the spatial pattern in occupational and environmental components and consistently identified some known occupational and environmental hot spots. Other areas at high risk for MM occurrence were highlighted, contributing to better characterize environmental exposures from industrial sources and suggesting a role of natural sources in the Alpine region.

Conclusion

The spatial pattern highlights areas at higher risk which are characterized by the presence of industrial sources - asbestos-cement, metallurgic, engineering, textile industries - and of natural sources in the Alpine region. The multivariate hierarchical Bayesian model was able to disentangle the geographical distribution of MM cases in two components interpreted as occupational and environmental.

Keywords

Malignant mesothelioma
Asbestos exposure
Hierarchical Bayesian models
Epidemiological surveillance

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