Achille Cernigliaro

The SESPIR Project (Epidemiological Surveillance of Health Status of Resident Population Around the Waste Treatment Plants) assessed the impact on health of residents nearby incinerators, landfills and mechanical biological treatment plants in five Italian regions (Emilia-Romagna, Piedmont, Lazio, Campania, and Sicily). The assessment procedure took into account the available knowledge on health effects of waste disposal facilities. Analyses were related to three different scenarios: a Baseline scenario, referred to plants active in 2008-2009; the regional future scenario, with plants expected in the waste regional plans; a virtuous scenario (Green 2020), based on a policy management of municipal solid waste (MSW) through the reduction of production and an intense recovery policy. Facing with a total population of around 24 million for the 5 regions, the residents nearby the plants were more than 380,000 people at Baseline. Such a population is reduced to approximately 330.000 inhabitants and 170.000 inhabitants in the regional and Green 2020 scenarios, respectively. The health impact was assessed for the period 2008-2040. At Baseline, 1-2 cases per year of cancer attributable to MSW plants were estimated, as well as 26 cases per year of adverse pregnancy outcomes (including low birth weight and birth defects), 102 persons with respiratory symptoms, and about a thousand affected from annoyance caused by odours. These annual estimates are translated into 2,725 years of life with disability (DALYs) estimated for the entire period. The DALYs are reduced by approximately 20% and 80% in the two future scenarios. Even in these cases, health impact is given by the greater effects on pregnancy and the annoyance associated with the odours of plants. In spite of the limitations due to the inevitable assumptions required by the present exercise, the proposed methodology is suitable for a first approach to assess different policies that can be adopted in regional planning in the field of waste management. The greatest reduction in health impact is achieved with a virtuous policy of reducing waste production and a significant increase in the collection and recycling of waste.

The municipality of Pace del Mela, together with Milazzo and San Filippo del Mela, has been recognized as a contaminated site of national concern. The purpose of the present study is to evaluate the health status of subjects resident in the Gabbia district, which is close to the industrial areas of both, Pace del Mela and Milazzo. All streets and addresses of the area of interest have been identified, taking into account their changes in name over time. The cohort of subjects who lived in the area for any period of time from September 1st, 1984, through December 31st, 2007 has been reconstructed by manual consultation of the Registrar Office files. Standardized mortality ratios, specific for cause, age class, gender and calendar period, have been computed using as reference the Sicilian population. Standardised incidence ratios, based on regional hospital discharge files, have been computed for the years 2001-2007. The cohort is constituted by 457 subjects, 230 men and 227 women. Ascertainment of vital status has not been possible for 39 subjects, corresponding to 8.5% of the cohort. Observed mortality for all causes and for all cancers is consistent with expected figures (62 observed vs 63 expected and 14 observed vs 15 expected, respectively). Observed cancer morbidity is inferior to the corresponding expected figure (SIR=0.49, CI 95%: 0.31-0.79). The health profile of the Gabbia district population, as estimated from mortality and hospital discharge records, does not show major departures from expected figures.

The present paper estimates the burden of asbestos-related disease among asbestos-cement production workers of the Sacelit plant that operated in San Filippo del Mela (Province of Messina) from 1958 through 1993. The cohort was enumerated by the local committee of formerly exposed workers, with whom a collaboration was set up. The cohort includes 198 subjects with complete individual anagraphic information, out of 231 previous workers identified by the committee. A record-linkage with the Sicilian centre of the National mesothelioma registry enabled estimation of mesothelioma incidence for the years 1998-2008. Standardised proportionate mortality (SPMR) for asbestos-related causes was computed for the years 1986-2009. Sicilian Region constituted the reference population. The rationale for using SPMR rather than standardized mortality ratio (SMR) was a consequence for the lack of company files from which to obtain dates of start and termination of employment, and thus to compute person-years of observation, following the guidelines of the international scientific literature. Standardised incidence ratio (SIR) for mesothelioma in the overall cohort was 251 (4 observed, 0.02 expected). Proportionate mortality analysis among male subjects showed significant increases for pneumoconiosis (SPMR 80.1, 5 observed), lung cancer (SPMR 2.81, 10 observed) and pleural neoplasms (SPMR 19.4, 2 observed). Notwithstanding limitations in cohort reconstruction, for which the proportion of eligible subjects was 87.5% of those detected by the local committee, and the lack of information on duration of employment, it was possible to estimate a significant increase of the incidence of pleural mesothelioma with respect to Sicilian population. Also mortality from asbestos-related causes was in excess with respect to the regional reference population.

The relationship between air pollution and mortality has been well established in national and international scientific literature. This study reports the results of the EpiAir Project relative to the effect of air pollution on mortality in 10 Italian cities during 2001-2005. The association between particulate matter (PM10) and gases (nitrogen dioxide, NO2, and ozone, O3), and all natural mortality, as well as cardiac, cerebrovascular and respiratory mortality, is presented. Specific issues have been investigated, such as the latency of the air pollution-mortality effects and the identification of individual demographic characteristics and clinical conditions that result in greater susceptibility to the effects of particulate matter. the study population consisted of 276,205 subjects aged 35+ years old, resident in one of the 10 Italian cities studied, which died in the city between 2001-2005. For each subject, information was collected on cause of death, location of death, demographical variables and hospital discharge diagnoses in the previous 2-year period. The statistical analysis was adjusted for the relevant temporal and meteorological factors using the case-crossover approach. The results for ozone are limited to the warm semester (April through September). An analysis of the association between air pollution and mortality was conducted for each city, and the city-specific estimates were meta-analyzed on a second level to obtain a pooled result, and reported inter-city heterogeneity. a short-term effect of PM10 on mortality has been detected for all the groups of causes considered, with latencies ranging from lag 0 for cerebrovascular mortality to lag 0-3 for respiratory mortality. The association between NO2 and mortality displays strong and similar effects for all death causes, with prolonged effects (lag 0-5) for all groups of causes. The results for O3 are similar to those found for NO2, with prolonged latency (lag 0-5) for all causes of death with the exception of cerebrovascular mortality, for which a delayed effect (lag 3-5) was identified. Individual susceptibility factors of the PM10-natural mortality association include age, as elderly subjects are especially vulnerable to the effects of particles. the main results of the study suggest that the air pollution originated by vehicular traffic is the most relevant environmental problem in Italian cities from a public health viewpoint.

To construct a composite municipal index of socioeconomic position (SEP) and to describe socioeconomic disparities in mortality within Sicilian elderly inhabitants (age 65+). 2001 Sicily Census data were used to develop a 5-level SEP index for the 390 municipalities of the Region. Education, occupation, housing tenure, family composition and immigration were considered in order to perform a factor analysis. We used Sicilian Mortality Registry data to compute standardized mortality rates by gender. The SEP index was used for mortality from all causes and for most common causes of death in elderly population. Rates, with 95% confidence intervals, were computed to compare mortality in each level of SEP to the highest level. there were socioeconomic disparities both in overall and in cause-specific mortality. Progressively higher mortality rates with lower SEP were observed for overall mortality (ratio between extreme categories: 1.16 in men, 1.14 in women), as well for mortality from cardiovascular diseases in both genders (ratio between extreme categories: 1.12 in men, 1.09 in women), from respiratory disease in men (ratio between extreme categories: 1.20), and from endocrine glands diseases in women (ratio between extreme categories: 1.35). For deaths from cancer and from diseases of the digestive system mortalities, in both genders, we found higher risks within the lowest SEP level as compared to the highest. Cardiovascular diseases contributed the most to the socioeconomic differences in overall mortality. Within the Sicilian elderly population, socioeconomic position is associated with mortality. The highest mortality rates were observed in the most disadvantaged municipalities. Moreover, mortality rates were oddly distributed by gender.

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. 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. 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). 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.

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. 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. 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. 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.