Pleural mesothelioma risk by industry and occupation: results from the Multicentre Italian Study on the Etiology of Mesothelioma (MISEM)

Abstract

Background: The Italian mesothelioma registry (ReNaM) estimates mesothelioma incidence and addresses its etiology by assessing cases' exposures but cannot provide relative risk estimates.

Objectives: i) To estimate pleural mesothelioma relative risk by industry and occupation and by ReNaM categories of asbestos exposure; and ii) to provide quantitative estimates of the exposure-response relationship.

Methods: A population-based mesothelioma case-control study was conducted in 2012-2014 in five Italian regions. Cases and age and gender frequency-matched controls were interviewed using a standard ReNaM questionnaire. Experts coded work histories according to international standard classifications of industries/occupations and assigned asbestos exposure according to ReNaM categories. Job codes were further linked to SYN-JEM, a quantitative job-exposure matrix. Cumulative exposure (CE, f/mL-years) was computed by summing individual exposures over lifetime work history. Unconditional logistic regression analyses adjusted by gender, centre and age were fitted to calculate odds ratios (OR) and 95% confidence intervals (CI).

Results: Among men we observed increased risks of mesothelioma in many industries and associated occupations, including: asbestos-cement (OR = 3.43), manufacture of railroad equipment (OR = 8.07), shipbuilding and repairing (OR = 2.34), iron and steel mills (OR = 2.15), and construction (OR = 1.94). ORs by ReNaM exposure categories were as follows: definite/probable occupational exposure (OR = 15.8, men; OR = 8.80, women), possible occupational (OR = 2.82, men; OR = 3.70, women), sharing home with an exposed worker (OR = 2.55, men; OR = 10.3, women), residential (OR = 2.14, men; OR = 3.24, women). Based on SYN-JEM, mesothelioma risk increased by almost 30% per f/mL-year (OR = 1.28, CI 1.16-1.42).

Conclusions: Out study involved five regions with historically different types and levels of industrial development, encompassing one third of the Italian population and half of Italian mesothelioma cases. As expected, we found increased pleural mesothelioma risk in the asbestos industry and in trades with large consumption of asbestos materials. Clear associations were found using both qualitative (ReNaM classifications) and quantitative estimates (using SYN-JEM) of past asbestos exposure, with clear evidence of an exposure-response relationship.

Keywords: Asbestos; Case–control study; Exposure assessment; Occupational exposure; Pleural mesothelioma.

Fig. 1

Odds ratios and 95% confidence intervals for pleural mesothelioma by gender and industry, according to the International Standard Industry Classification (ISIC, 4-digit codes), 1971 – Industries with at least 20 exposed cases and controls—the MISEM study, 2012–2015, Italy

Fig. 2

Odds ratios and 95% confidence intervals for pleural mesothelioma by gender and occupation, according to the International Standard Code of Occupations (ISCO, 3-digit codes), 1968 – Occupations with at least 20 exposed cases and controls—the MISEM study, 2012–2015, Italy

Fig. 3

Odds ratios and 95% confidence intervals for pleural mesothelioma by cumulative exposure to asbestos (natural log-scale) modelled as a restricted cubic spline with five knots at 10/25/50/75/90 percentiles, men, lag10, 20 and 30 years – the MISEM study, 2012–2015, Italy