Early Mortality from Malignant Neoplasms of Pleura, a Proxy for Environmental Exposure to Asbestos in Childhood

The issue of health risk from asbestos exposure in children is rarely addressed, mainly for the long median latency of asbestos-related diseases (45 years for pleural mesothelioma): if children are exposed to asbestos, the effects will occur so late that the causal link can be hidden. As part of SENTIERI KIDS, a project on child health in contaminated sites, mortality from malignant neoplasms of pleura (MNP) in young adults (=50 years) was used as a proxy for environmental exposure to asbestos in childhood. The National Mortality Database, available at the Statistics Unit of the National Institute of Health, was used to analyze early mortality for MNP in Italy: ICD 9th Revision, code 163 (1980-2002), and ICD 10th Revision, codes C45.0 and C38.4 (2003-2010). Standardized rates (SR) and standardized mortality ratios (SMRs) were calculated with 90% confidence intervals (90%CI), using as reference the Italian population for regional estimates, and regional populations for municipal estimates. In Italy, 1594 early deaths from MNP were recorded from 1980 to 2010 (55 per year on average, annual SR=0.2 x 100,000). Friuli, Liguria, Lombardia and Piedmont, the regions mostly affected by activities involving asbestos exposure, display high risks (respectively: SMR=133, 90%CI 102-170, 46 obs; SMR=207, 174-245, 97 obs; SMR=119, 109-131, 319 obs, SMR=164, 146-184, 206 obs). This study identified 147 municipalities where early mortality for MNP is significantly higher than expected. In Biancavilla, a small municipality (20,000 people) where building material extracted from the local quarry was contaminated by amphibolic fibers, 6 early deaths versus 0.5 expected were observed. Within a radius of 10 km from Biancavilla MNP deaths rose to 11 (SMR=367, CI90% 206-608). Results highlight the need to further analyze the space and time distribution of early MNP deaths as a tool to confirm presence of environmental contamination by asbestos and to detect areas at risk not yet identified.