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Objectives: to provide an overview of the geographical distribution of mesothelioma and asbestosis deaths in the Campania Region (Southern Italy) occurred from 2005 to 2018 and to identify areas at higher risk., Design: for each municipality, Standardized Mortality Ratios (SMRs) for mesothelioma and asbestosis have been estimated from the mortality data provided by the Italian National Institute of Statistics (Istat). Deaths for which mesothelioma and asbestosis were identified as the underlying causes, according to the classification system ICD-10 codes (C45 and J61, respectively), were included. Expected cases were estimated applying age- and gender-specific mortality rates in Campania on resident populations of each municipality. Furthermore, the association between the municipal SMR and the local socioeconomic deprivation index based on the 2011 General Census of Population and Housing was also analysed., Setting and Participants: Campania Region., Main Outcomes Measures: the study outcomes were standardized mortality ratios for mesothelioma and asbestosis and the identification of territorial subareas., Results: a total of 998 deaths attributed to mesothelioma and 62 to asbestosis were identified. No cases of death due to mesothelioma or asbestosis were reported in the province of Benevento. A significant increase in mortality due to mesothelioma was observed across 34 municipalities. These findings show that several municipalities within the province of Naples display a high increase in mortality due to mesothelioma and asbestosis, with 506 deaths in total and 246 cases recorded in the municipality of Naples against 178,37 expected (SMR 1,38; 90%CI 1.24-1.53). In 15 municipalities, a notable increase in mortality for asbestosis was recorded; in Naples, 28 cases occurred (SMR 2,51; 90%CI 1.84-3.42). The overlap between mortality maps for mesothelioma and asbestosis confirms the existence of areas subjected to definite and prolonged asbestos exposure. Additionally, a correlation with the deprivation index was noted: the pooled SMR by quintiles increases with higher quintiles of the deprivation index, for both mesothelioma and asbestosis., Conclusions: results highlight the crucial need for epidemiological surveillance of asbestos-related diseases in Campania. Actively searching out for new cases of mesothelioma in the entire region is a crucial task in primary prevention of occupational, environmental, and domestic exposures to asbestos.

Objectives: to develop an occupational health risk index that can help to introduce the occupational risk component into epidemiological studies and assess the level of occupational risk in Italian municipalities useful for supporting prevention measures., Design: defi nition of a municipal index as a combination of occupational and territorial indicators derived from national registers of occupational data and environmental archives., Setting and Participants: the index composition is based on data on work injuries, occupational diseases and workers exposed to carcinogens in the years 2015-2019 available at the municipal level, as well as data on municipalities hosting sites of national interest for environmental remediation (SIN) and those in which big industrial facilities (GIE), registered as pollutant emitters, are located., Main Outcome Measures: standardized rates of occupational injuries and occupational diseases occurred in Italian municipalities were calculated from data collected by the Italian National Institute for Insurance against Accidents at Work (Inail) in relation to the working-age population (15-69 and 15+ for injuries and occupational diseases, respectively), estimated by the Italian National Statistical Institute (Istat) in 2018. In addition, data from the National Information System on Occupational Exposure to carcinogens (SIREP) were included, from which raw rates were calculated at municipal level. Finally, two other indicators were included, describing the presence/absence of a SIN and the number of GIEs industrial facilities in each municipality. The index of occupational health risk (INDORS) is calculated by summing standardised values of the above fi ve indicators as a continuous variable and it was also classifi ed by quintiles of population as a categorical variable. The association between cause-specific mortality and INDORS levels was evaluated using data on mortality occurring in 2015., Results: during the observation period 2,011,457, 131,353 and 140,183 events were recorded for injuries, occupational diseases and workers exposed to carcinogens, mainly among male workers. A municipal map of INDORS levels (1-5) shows a strong South-North gradient, in line with the Italian industrial geographical context. The contributions of the SIN and GIE indicators are higher in the hot spot municipalities located in the Southern regions and islands. Among the municipalities analysed 1,099 were classifi ed in the lowest risk level, 1,331 in the low-medium level, 1,619 in the medium level, 2,621 in the medium-high level and 1,284 in the highest risk level. The index shows a direct correlation with accidental mortality and an inverse correlation with all-cause and malignant neoplasm mortality., Conclusions: the proposed index can be useful to introduce the occupational risk dimension in ecological studies and results as a flexible tool to rank Italian municipalities in terms of occupational risk.

The effects of heat on health have been well documented, while less is known about the effects among agricultural workers. Our aim is to estimate the effects and impacts of heat on occupational injuries in the agricultural sector in Italy. Occupational injuries in the agricultural sector from the Italian national workers' compensation authority (INAIL) and daily mean air temperatures from Copernicus ERA5-land for a five-year period (2014-2018) were considered. Distributed lag non-linear models (DLNM) were used to estimate the relative risk and attributable injuries for increases in daily mean air temperatures between the 75th and 99th percentile and during heatwaves. Analyses were stratified by age, professional qualification, and severity of injury. A total of 150,422 agricultural injuries were considered and the overall relative risk of injury for exposure to high temperatures was 1.13 (95% CI: 1.08; 1.18). A higher risk was observed among younger workers (15-34 years) (1.23 95% CI: 1.14; 1.34) and occasional workers (1.25 95% CI: 1.03; 1.52). A total of 2050 heat-attributable injuries were estimated in the study period. Workers engaged in outdoor and labour-intensive activities in the agricultural sector are at greater risk of injury and these results can help target prevention actions for climate change adaptation.

Background/aim: Extreme temperatures have impact on the health and occupational injuries. The construction sector is particularly exposed. This study aims to investigate the association between extreme temperatures and occupation injuries in this sector, getting an insight in the main accidents-related parameters., Methods: Occupational injuries in the construction sector, with characteristic of accidents, were retrieved from Italian compensation data during years 2014-2019. Air temperatures were derived from ERA5-land Copernicus dataset. A region based time-series analysis, in which an over-dispersed Poisson generalized linear regression model, accounting for potential non-linearity of the exposure- response curve and delayed effect, was applied, and followed by a meta-analysis of region-specific estimates to obtain a national estimate. The relative risk (RR) and attributable cases of work-related injuries for an increase in mean temperature above the 75th percentile (hot) and for a decrease below the 25th percentile (cold) were estimated, with effect modifications by different accidents-related parameters., Results: The study identified 184,936 construction occupational injuries. There was an overall significant effect for high temperatures (relative risk (RR) 1.216 (95% CI: (1.095-1.350))) and a protective one for low temperatures (RR 0.901 (95% CI: 0.843-0.963)). For high temperatures we estimated 3,142 (95% CI: 1,772-4,482) attributable cases during the studied period. RRs from 1.11 to 1.30 were found during heat waves days. Unqualified workers, as well as masons and plumbers, were found to be at risk at high temperatures. Construction, quarry and industrial sites were the risky working environments, as well as specific physical activities like working with hand-held tools, operating with machine and handling of objects. Contact with sharp, pointed, rough, coarse 'Material Agent' were the more risky mode of injury in hot conditions., Conclusions: Prevention policies are needed to reduce the exposure to high temperatures of construction workers. Such policies will become a critical issue considering climate change., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.)