title: [Mortality and morbidity among municipal waste workers in Rome: a cohort study].
abstract: BACKGROUND
  The adverse health effects associated with waste treatment processes are of great concern as large population groups and workers may be exposed to refuse-derived toxic substances. The main effects are respiratory and gastrointestinal infections, reduced lung function, irritations, allergic reactions, and injuries.
  
  
  OBJECTIVE
  To evaluate morbidity and mortality among a cohort of municipal waste workers in Rome.
  
  
  METHODS
  All 6839 workers (18.6% women) involved in waste collection, transportation and landfill disposal employed since 01/01/1994, with a minimum period of employment of five years were enrolled and with follow-up until 31/12/2009. The assessment of vital status was carried out through linkages with information systems (municipality records, mortality and hospital information systems), and through contacts with municipalities of residence. Gender specific standardized mortality (SMR) and hospitalization (SHR) ratios were calculated, using regional population mortality (and hospitalization) rates.
  
  
  RESULTS
  Overall, in this cohort workers had the same mortality as the population of the Region. Hospitalizations for natural causes were significantly higher than expected among workers involved in transportation (SHR = 1.25, 95% CI = 1.13-1.38) and in waste collection (SHR(men) = 1.14, 95% CI = 1.07-1.22; SHR(women) = 1.65, 95% CI = 1.47-1.84). Among women there was an excess of hospitalizations for respiratory diseases (SHR = 1.95, 95% CI = 1.33-2.77), for digestive system disorders (SHR = 1.37, 95% CI = 1.03-1.79) and for injuries and intoxications (SHR = 2.28, 95% CI = 1.69-2. 99).
  
  
  CONCLUSIONS
  The study did not find any increased mortality among the workers of either sexes. Female workers deserve further surveillance mainly due to an increased risk of trauma and respiratory and gastrointestinal disorders.
authors.affiliation: Dipartimento di Epidemiologia del Servizio Sanitario Regionale, Regione Lazio. s.narduzzi@deplazio.it
authors.forename: Silvia
authors.initials: S
authors.lastname: Narduzzi
authors.forename: Carla
authors.initials: C
authors.lastname: Ancona
authors.forename: Giovanna
authors.initials: G
authors.lastname: Cappai
authors.forename: F
authors.initials: F
authors.lastname: Forastiere
mesh_terms: D000328:Adult; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D009784:Occupational Diseases / Q000453:epidemiology* / Q000401:mortality; D012384:Rome; D014504:Urban Health; D018505:Waste Management