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Background: the large amount of asbestos used in many Countries (including Italy) is causing an epidemic of asbestos related diseases, which is still ongoing because of their long latency., Objectives: this study is aimed at reconstructing Italian time series of deaths for mesothelioma in the period 1970-2009 and comparing Italian incidence and mortality data., Design, Setting, and Participants: deaths for pleural cancer (1970-2003,2006-2009) and mesothelioma (2003, 2006-2009) were recorded by the Italian Institute of Statistics (Istat) and provided by the Italian National Agency for New Technologies, Energy and the Environment (ENEA), incidence cases (1993-2008) were provided by the Italian mesotheliomas register (ReNaM) at the Italian National Workers' Compensation Authority (Inail). For the period before ICD-10 implementation (1970-2002) and when Istat data (2004-2005) are lacking, mesothelioma deaths were estimated through statistical models (logistic, Poisson). National incidence and mortality data were compared during the overlapping period (2003, 2006-2008)., Results: the mortality curve strongly rises from 1970 and seems to be smoothed in the last years. Mortality caused by mesothelioma and incident cases with certain diagnosis are overlapping, as are mortality due to pleural cancer other than mesothelioma and mesothelioma incidence with uncertain diagnosis (probable/possible)., Conclusions: this epidemiological analysis of deaths encoded as pleural tumour suggests to carefully investigate space-temporal distribution before excluding they could be mesotheliomas. Some new lights have been thrown on the statistical behaviour of mesothelioma mortality.

Background: Occupational exposure to asbestos has been widely reported in the Region, but a high risk for non-occupational and environmental contaminations have also been documented., Objectives: To describe the geographical distribution ofpleural cancer deaths and compensated asbestosis cases from 1980 to 2001 in the Lazio Region., Methods: For each municipality Standardized Mortality Ratios (SMRs) for pleural cancer and Standardized Incidence Ratios (SIRs) for asbestosis were estimated. Expected cases were estimated from age and gender specific rates in Lazio. SatScan software was used to identify clusters and to verf;j their statistical significance., Results: 789 deaths from pleural cancer (495 males and 294 females) occurred in Lazio from 1980 to 2001. The standardized mortality rate per 100.000 inhabitants is 0,74 (0,95 for males and 0,54 for females). The main excess mortality from pleural cancer occurred in the municipalities of Civitavecchia (SMR: 269,9; 95% CI: 164,9 - 416,8), Colleferro (SMR: 304,9; 95% CI: 139,4-578,8) and Rocca Priora (SMR: 379,2; 95% CI: 103,3-970,9). Significant SIRs for compensated asbestosis cases were found in the industrial areas of the Naples-Rome highway and in the shipyard area of Civitavecchia. Nofemale compensated cases were found. The most important clusters were identified in the municipality of Civitavecchia for pleural cancer (p-value = 0,117) and in the Colleferro industrial area for compensated asbestosis cases (p-value = 0,001)., Conclusions: Epidemiological surveillance of incident cases of malignant mesothelioma in the Lazio Region and the investigation of modalities of asbestos exposure are urgently needed for prevention of occupational diseases.

Objective: To describe the mortality rates for motor neuron disease (MND) in Italy both at national level and at three large geographical sub-areas (Northern, Central, Southern Italy)., Design: Deaths for MND are coded accordingly to ICD (IX revision) with 335.2 code. Mortality for MND is analysed for the period 1980-99. Mortality rates are age-standardized on the structure of the 1991 Italian population. Mortality data are derived from the National Institute for Statistics (ISTAT) and are made available by the Epidemiological Database of the Italian National Agency for New Technologies, Energy and the Environment (ENEA)., Main Outcome Measures: Age adjusted mortality rates for MND are calculated for 5-year periods (1980-84, 1985-89, 1990-94, 1995-99) at both national level and three geographical sub-areas (north, center and south); sex and age specific mortality rates are also reported for two decades (1980-89 and 1990-99)., Results: During 1980-99 the annual age-standardized mortality rate in Italy was 1.35 x 100000 in males and 1.10 (x 100000) in females. In the period 1995-99 the mortality rates increased by 39.3% in males and 78.2% in females at national level when compared to 1980-84 rates (1.56 vs 1.12 deaths per 100000 for males and 1.39 vs 0.78 per 100000 for females in 1980-84 and 1995-99, respectively). In the three large geographical sub-areas such increases were 37.6%, 29.7% and 57% in males and 73%, 63.1% and 114.3% in females, respectively., Conclusion: The increase reported in this study is probably due to a mix of different factors as population ageing (age-specific rates reach a peak in the age class 70-74 years), better accuracy of death certificates, adoption of new clinical criteria and at last a wide spread of environmental risk factors (metals, solvents, pesticides, electromagnetic fields) and modification of life style (smoking, diet, professional sport).

Objective: To his study describes the geographical distribution of pleural cancer deaths and asbestosis cases from 1980 to 2000 in Sardinia Region (Italy). For both conditions regionwide registration systems have been available for a relatively long time and allow the identification of statistically significant clusters., Design: For each town we have estimated Standardized Mortality Ratios (SMRs) for pleural cancer and Standardized Incidence Ratios (SIRs) for asbestosis. Expected cases were estimated from age- and gender specific rates in Sardinia. SatScan software was used to identify clusters and to verify their statistical significance., Setting: Sardinia Region (Italy)., Main Outcome Measures: Standardized mortality and incidence rates respectively for pleural cancers and asbestosis cases and territorial clusters., Results: The most important cluster of pleural cancer was identified in the area defined by Carloforte, Calasetta, Portoscuso and Sant'Antioco municipalities (Southwestern Sardinia) with 15 observed cases (p value= 0.003). Other clusters were detected in the municipality of La Maddalena (11 observed cases against 1.91, expected p value= 0.008) and in Southern Sardinia between Cagliari and Sarroch (p value= 0.018). The town of Marrubiu is clearly the most important cluster (p value= 0. 001) with 6 asbestosis cases in the period., Conclusions: These results indicate the urgency of the epidemiological surveillance of asbestos related diseases in Sardinia. The active search for incident cases of malignant mesothelioma in the whole Region and the analysis of modalities of asbestos exposure (according to national guidelines) is an indispensable tool for the primary prevention of occupational, environmental and domestic exposures from unknown asbestos sources of contamination.

Objective: To investigate cause-specific mortality in an area of Campania region, in the surroundings of Naples, characterized by many toxic waste dumping grounds sites and by widespread burning of urban wastes., Design: The study area was characterized by examining the spatial distribution of waste disposal sites and toxic waste dumping grounds, using a geographic information system (GIS). Mortality (1986-2000) was studied in the three municipalities of Giugliano in Campania, Qualiano and Villaricca, encompassing a population of about 150,000 inhabitants. Mortality rates of the population resident in the Campania region were used in order to generate expected figures., Outcomes: Causes of death of a priori interest where those previously associated to residence in the neighbourhood of (toxic) waste sites, including lung cancer, bladder cancer, leukemia and liver cancer., Results: Overall 39 waste sites, 27 of which characterized by the likely presence of toxic wastes, were identified in the area of interest. A good agreement was found between two independent surveys of the Regional Environmental Protection Agency and of the environmentalist association Legambiente. Cancer mortality was significantly increased, with special reference to malignant neoplasm of lung, pleura, larynx, bladder, liver and brain. Circulatory diseases were also significantly in excess and diabetes showed some increases., Conclusions: Mortality statistics provide preliminary evidence of the disease load in the area. Mapping waste dumping grounds provides information for defining high risk areas. Improvements in exposure assessment together with the use of a range of health data (hospital discharge cards, malformation notifications, observations of general practitioners) will contribute to second generation studies aimed at inferring causal relationships.

By assessing mortality causes, the authors have described the health status of people living in 3 areas of Tuscany around Livorno, Orbetello and Piombino municipalities. Direct standard mortality and local standard mortality ratios were assessed as regards the years 1988?1997. Total mortality turned out to be equal or lower than the Italian average, with the exception of the women from Livorno municipality. Cancer mortality is higher in Livorno area, among females in Orbetello area and males in both Orbetello and Piombino municipalities. As regards regional mortality, the situation in Livorno seems to be the worst, followed by Orbetello and Piombino.

The aim of the present work was to compare mortality data during 1980-94 (24 causes of death for males and 25 for females) in populations living in municipalities with different urbanization levels of seven Italian regions (Piemonte, Lombardia, Emilia Romagna, Marche, Lazio, Campania and Sicilia). Urbanization levels were established following the classification of the Italian Institute of Statistics (ISTAT, Classificazione dei comuni secondo le caratteristiche urbane e rurali, 1986). A quite uniform configuration of causes of death with characteristic excesses in the urban environment was evident. The only exception was represented by the male population in Lombardia, probably due to the prevalence of occupational exposure. The urban excesses included: all tumors (also for the population < 64 year old), trachea, bronchi and lung tumors (also < 64 year old people), colorectal cancer, bladder cancer, male liver cancer and female breast cancer. Mortality due to stomach cancer and, only in males, to larynx cancer was lower in urban than in the other types areas, except the Southern regions. Concerning some non tumoral pathologies a more dyshomogeneous situation was observed, with a prevalence of urban defects in Piemonte and Lombardia, of urban excesses in the Southern regions and of both excesses and defects in Emilia Romagna and the Central regions. The "semi-rural" and "rural" types municipalities resulted quite similar, with the exception of Campania and Lazio. In fact, in these two regions a greater association with stomach cancer and lower mortality for all other tumors compared to the urban and, at a lesser extent, to the semi-urban municipalities was found. However, the lower tumor mortality was partly balanced by some other causes of death, again with the exception of Campania and at a lesser extent of Sicilia. On the basis of the causes of death comparisons, the semi-urban municipalities seem to represent a transition type between the urban and the rural ones.