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Epidemiol Prev. 2017 Sep-Dec;41(5-6):271-278. doi: 10.19191/EP17.5-6.P271.088.

[Mortality study update of workers exposed to vinyl chloride in plants located in Ferrara and Ravenna (Emilia-Romagna Region, Northern Italy)].

[Article in Italian]

Author information

1
Dipartimento di sanità pubblica, Azienda USL Bologna.
2
Dipartimento di sanità pubblica, Azienda USL di Ravenna.
3
Dipartimento di sanità pubblica, Azienda USL di Ferrara. m.spagnolo@ausl.fe.it.
4
Dipartimento di sanità pubblica, Azienda USL di Ferrara.
5
Insegnamento di sicurezza sui luoghi di lavoro, Università di Ferrara.
6
Dipartimento ambiente e connessa prevenzione primaria, Istituto superiore di sanità, Roma.
7
Dipartimento di biologia animale e dell'uomo, Università "Sapienza", Roma.

Abstract

OBJECTIVES:

to update the mortality study of subjects exposed to vinyl chloride in the phases of synthesis of the monomer and polymerization in the plants of Ferrara and Ravenna (Emilia-Romagna Region, Northern Italy).

DESIGN:

both for the whole cohort and for the two plants, standardized mortality ratios (SMRs), with 95% confidence intervals (95%CI), were calculated for different death causes, then stratified by duration and latency, periods of the beginning of work and cumulative exposure (ppm-years).

SETTING AND PARTICIPANTS:

the cohort includes 1,540 subjects (469 in Ferrara hired from 1953 to 1999; 1,071 in Ravenna hired from 1959 to 2000), with at least six months of work.

RESULTS:

by the end of the follow-up (31.12.2013), 348 deaths occurred. Overall observed mortality, contrasted to that expected based on Emilia-Romagna Region mortality rates, appeared to be lower than expected in the whole cohort (348 cases, SMR: 0.85; 95%CI 0.77-0.95) and in Ravenna (173 cases, SMR: 0.71; 95%CI 0.61-0.83). Mortality for all neoplasms was in excess in Ferrara (79 cases, SMR: 1.27; 95%CI 1.02-1.58), but lower than expected in Ravenna (83 cases, SMR: 0.80; 95%CI 0.64-0.99). An excess in mortality was observed in the whole cohort (16 cases, SMR: 1.74; 95%CI 1.07-2.85) and in Ferrara for liver cancer (7 cases, SMR: 2.12; 95%CI 1.02-4.46), and only in Ferrara for respiratory tract cancer (30 cases, SMR: 1.45; 95%CI 1.02-2.07) and larynx cancer (4 cases, SMR: 3.35; 95%CI 1.26-8.92). In the whole cohort, SMR for liver cancer was in excess since a cumulative exposure of 5,000 ppm-year and 12 cases belong to the job title of autoclave workers (12 cases, SMR 4.6; 95%CI 2.6-8.0), duration of work higher than 20 years (8 cases, SMR 2.4; 95%CI 1.2-4.9), and latency higher than 40 years (7 cases, SMR 2.5; 95%CI 1.2-5.2). The excess in mortality for lung cancer is statistically significant for and with cumulative exposure higher than 7,330 ppm-years (6 cases, SMR 3.2 95%CI 1.4-7.0). There are not excesses among subjects hired after 1971.

CONCLUSIONS:

the study findings confirm and expand the ones of previous studies. It was not possible to apply a best evidence approach to the study of liver cancer, and consequently it is not possible to distinguish between hepatic angiosarcoma and hepatocellular carcinoma. The evidence of a causal link between vinyl chloride exposure and liver cancer is anyhow confirmed. The causal link between vinyl chloride exposure and lung cancer must be further investigated.

PMID:
29119762
DOI:
10.19191/EP17.5-6.P271.088
[Indexed for MEDLINE]

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