Predictors of Lung Cancer Risk: An Ecological Study Using Mortality and Environmental Data by Municipalities in Italy

Claudio Gariazzo, Alessandra Binazzi, Marco Alfò, Stefania Massari, Massimo Stafoggia and Alessandro Marinaccio
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Claudio Gariazzo: Occupational and Environmental Medicine Epidemiology and Hygiene Department, Italian Workers’ Compensation Authority (INAIL), 00144 Rome, Italy
Alessandra Binazzi: Occupational and Environmental Medicine Epidemiology and Hygiene Department, Italian Workers’ Compensation Authority (INAIL), 00144 Rome, Italy
Marco Alfò: Department of Statistic, University of Roma “Sapienza”, 00185 Rome, Italy
Stefania Massari: Occupational and Environmental Medicine Epidemiology and Hygiene Department, Italian Workers’ Compensation Authority (INAIL), 00144 Rome, Italy
Massimo Stafoggia: Department of Epidemiology, Lazio Regional Health Service, ASL Roma 1, 00154 Rome, Italy
Alessandro Marinaccio: Occupational and Environmental Medicine Epidemiology and Hygiene Department, Italian Workers’ Compensation Authority (INAIL), 00144 Rome, Italy

IJERPH, 2021, vol. 18, issue 4, 1-15

Abstract: Lung cancer (LC) mortality remains a consistent part of the total deaths occurring worldwide. Its etiology is complex as it involves multifactorial components. This work aims in providing an epidemiological assessment on occupational and environmental factors associated to LC risk by means of an ecological study involving the 8092 Italian municipalities for the period 2006–2015. We consider mortality data from mesothelioma as proxy of asbestos exposure, as well as PM 2.5 and radon levels as a proxy of environmental origin. The compensated cases for occupational respiratory diseases, urbanization and deprivation were included as predictors. We used a negative binomial distribution for the response, with analysis stratified by gender. We estimated that asbestos is responsible for about 1.1% (95% CI: 0.8, 1.4) and 0.5% (95% CI: 0.2, 0.8) of LC mortality in males and females, respectively. The corresponding figures are 14.0% (95% CI: 12.5, 15.7) and 16.3% (95% CI: 16.2, 16.3) for PM 2.5 exposure, and 3.9% (95% CI: 3.5, 4.2) and 1.6% (95% CI: 1.4, 1.7) for radon exposure. The assessment of determinants contribution to observed LC deaths is crucial for improving awareness of its origin, leading to increase the equity of the welfare system.

Keywords: asbestos; COPD; ischemic heart; PM 2.5; radon; urbanization; deprivation; occupational respiratory diseases (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2021
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