title: Mesothelioma mortality surveillance and asbestos exposure tracking in Italy.
abstract: BACKGROUND
  Spatial distribution of mortality from pleural mesothelioma (which in the ICD-10 Revision has a specific code: C45.0) in Italy for the period 2003-2009 is described. Previous mortality studies at national level employed the topographic code "Malignant neoplasms of pleura", because of unavailability of a specific code in ICD-9 Revision for pleural mesothelioma.
  
  
  METHODS
  Standardized mortality ratios were computed for all municipalities, using each regional population as reference; for municipalities in Regions with rate higher than the national rate, the latter has been used as reference. SMRs were computed specifically also for each Italian Polluted Sites "of national concern for environmental remediation" (IPS) with asbestos exposure sources, composed by one or more municipalities, using regional rate as reference. Spatial Scan Statistics procedure, using SatScan software, was applied in cluster analysis: the country was divided into geographic macro-areas and the relative risks (RR) express the ratio of risk within the cluster to the risk of the macro-area outside the cluster. Clusters with p-value < 0.10 were selected.
  
  
  RESULTS
  The national standardized annual mortality rate was 1.7 cases per 100 000. Several areas with evident burden of asbestos-related disease were detected. Significant clusters were found in correspondence to asbestos-cement industries (e.g. Casale Monferrato, women: RR = 28.7), shipyards (e.g. Trieste, men: RR = 4.8), petrochemical industries (e.g. Priolo, men: RR = 6.9) and a stone quarry contaminated by fluoro-edenite fibres (Biancavilla, women: RR = 25.9). Some of the increased clusters correspond to IPS.
  
  
  CONCLUSIONS
  The results may contribute to detect asbestos exposure and to set priorites for environmental remediation.
authors.affiliation: Dipartimento di Ambiente e Connessa Prevenzione Primaria; Istituto Superiore di Sanità, Rome, Italy. lucia.fazzo@iss.it
authors.forename: Lucia
authors.initials: L
authors.lastname: Fazzo
authors.forename: Giada
authors.initials: G
authors.lastname: Minelli
authors.forename: Marco
authors.initials: M
authors.lastname: De Santis
authors.forename: Caterina
authors.initials: C
authors.lastname: Bruno
authors.forename: Amerigo
authors.initials: A
authors.lastname: Zona
authors.forename: Alessandro
authors.initials: A
authors.lastname: Marinaccio
authors.forename: Susanna
authors.initials: S
authors.lastname: Conti
authors.forename: Roberta
authors.initials: R
authors.lastname: Pirastu
authors.forename: Pietro
authors.initials: P
authors.lastname: Comba
mesh_terms: D000328:Adult; D000368:Aged; D001194:Asbestos / Q000009:adverse effects*; D016000:Cluster Analysis; D016208:Databases, Factual; D052918:Environmental Restoration and Remediation; D005260:Female; D006801:Humans; D007221:Industry; D038801:International Classification of Diseases; D007558:Italy / Q000453:epidemiology; D008297:Male; D008654:Mesothelioma / Q000401:mortality*; D008875:Middle Aged; D016273:Occupational Exposure / Q000706:statistics & numerical data*
chemical_list: D001194:Asbestos