Pleural mesothelioma risk in the construction industry: a case-control study in Italy, 2000-2018

Abstract

Objectives: Workers in the construction industry have been exposed to asbestos in various occupations. In Italy, a National Mesothelioma Registry has been implemented more than 20 years ago. Using cases selected from this registry and exploiting existing control data sets, we estimated relative risks for pleural mesothelioma (PM) among construction workers.

Design: Case-control study.

Setting: Cases from the National Mesothelioma Registry (2000-2018), controls from three previous case-control studies.

Methods: We selected male PM incident cases diagnosed in 2000-2018. Population controls were taken from three studies performed in six Italian regions within two periods (2002-2004 and 2012-2016). Age-adjusted and period-adjusted unconditional logistic regression models were fitted to estimate odds ratios (OR) for occupations in the construction industry. We followed two approaches, one (primary) excluding and the other (secondary) including subjects employed in other non-construction blue collar occupations for >5 years. For both approaches, we performed an overall analysis including all cases and, given the incomplete temporal and geographic overlap of cases and controls, three time or/and space restricted sensitivity analyses.

Results: The whole data set included 15 592 cases and 2210 controls. With the primary approach (4797 cases and 1085 controls), OR was 3.64 (2181 cases) for subjects ever employed in construction. We found elevated risks for blue-collar occupations (1993 cases, OR 4.52), including bricklayers (988 cases, OR 7.05), general construction workers (320 cases, OR 4.66), plumbers and pipe fitters (305 cases, OR 9.13), painters (104 cases, OR 2.17) and several others. Sensitivity analyses yielded very similar findings. Using the secondary approach, we observed similar patterns, but ORs were remarkably lower.

Conclusions: We found markedly increased PM risks for most occupations in the construction industry. These findings are relevant for compensation of subjects affected with mesothelioma in the construction industry.

Keywords: case-control studies; epidemiology; occupational & industrial medicine; public health; respiratory tract tumours.

Figure 1

Diagram showing numbers of male pleural mesothelioma cases and controls across the years and their main characteristics, Italy, 2000–2018. Cases from all years and areas (analysis A1). In the primary approach, subjects ever employed in non-construction blue-collar occupations for >5 years were excluded; in the secondary approach, all subjects (also those ever employed in non-construction blue-collar occupation for >5 years) were included. CARA, Cholangiocarcinoma Aetiology: Role of Asbestos; EAGLE, Environment And Genetics in Lung cancer Aetiology; MISEM, Multicentre Italian Study on the Aetiology of Mesothelioma; ReNaM, Registro Nazionale Mesoteliomi.

Figure 2

Pleural mesothelioma ORs and 90% CIs for selected occupations in men in the construction industry (ISIC-71 code 5000) in four analyses, Italy, 2000–2018. Results of the primary approach (subjects ever employed in non-construction blue-collar occupations for >5 years excluded): ever employed in construction, blue collars and three-digits ISCO-68 unit groups within minor group 95 ‘bricklayers, carpenters and other construction workers’. A1, overall analysis using all Italian cases, 2000–2018; A2, analysis with cases selected from the same periods of controls; A3, analysis with cases selected from the same areas of controls; A4, analysis with cases selected from the same periods and areas of controls. In parentheses, the International Standard Classification of Occupations (ISCO, 1968) codes. ISIC, International Standard Industrial Classification.

Figure 3

Pleural mesothelioma ORs and 90% CIs for selected occupations in men in the construction industry (ISIC-71 code 5000) in four analyses, Italy, 2000–2018. Results of the primary approach (subjects ever employed in non-construction blue-collar occupations for >5 years excluded): other three-digit ISCO-68 unit groups. A1, overall analysis using all Italian cases, 2000–2018; A2, analysis with cases selected from the same periods of controls; A3, analysis with cases selected from the same areas of controls; A4, analysis with cases selected from the same periods and areas of controls. In parentheses, the International Standard Classification of Occupations (ISCO, 1968) codes. ISIC, International Standard Industrial Classification.