Mortality for chronic-degenerative diseases in Tuscany: Ecological study comparing neighboring areas with substantial differences in environmental pollution

Abstract

Objectives: Environmental pollution is associated with morbidity and mortality for chronic-degenerative diseases. Recent data points out a relationship between proximity to industrial plants and mortality due to neoplasms. The aim of this study has been to compare mortality due to chronic-degenerative diseases in the area of Tuscany (Bassa Val di Cecina), Italy, characterized by the presence of 2 neighboring municipalities similar in terms of size but with substantial differences in industrial activities: Rosignano (the site of chemical, energy production and waste processing industries) and Cecina (with no polluting activity). Material and Methods: Standardized mortality rates for the 2001-2010 decade were calculated; the data of the whole Tuscany was assumed as reference. Environmental levels of pollutants were obtained by databases of the Environmental Protection Agency of Tuscany Region (Agenzia Regionale per la Protezione Ambientale della Toscana -ARPAT). Maximum tolerated pollutant levels set by national laws were assumed as reference. Results: In the whole Bassa Val di Cecina, significantly elevated standardized mortality rates due to mesothelioma, ischemic heart diseases, cerebrovascular diseases and Alzheimer and other degenerative diseases of nervous system were observed. In the municipality of Rosignano, a significant excess of mortality for all these groups of diseases was confirmed. On the contrary, the municipality of Cecina showed only significantly higher mortality rates for ischemic heart diseases. Elevated levels of heavy metals

Environment in Children’s Health: A New Challenge for Risk Assessment

“…The relationship between environmental pollution and morbidity and mortality from neoplasms and respiratory diseases has been demonstrated in various epidemiological studies [ 64 ]. More recently, an association between environmental data and chronic degenerative diseases has been documented, including cardiovascular disease [ 65 ]. This study was conducted in a cohort of Italian adult subjects living in Tuscany.…”

Letter to the Editor (July 28, 2017) concerning the paper “Mortality for chronic-degenerative diseases in Tuscany: Ecological study comparing neighboring areas with substantial difference in environmental pollution”

“…Dear Editor, Marabotti et al have recently published an ecological study on mortality for chronic-degenerative diseases in the Tuscan area [1]. As we are operating the Tuscan Regional Mortality Registry, the Tuscan Cancer Registry and the Tuscan Mesothelioma Registry at the Cancer Research and Prevention Institute (Istituto per lo Studio e la Prevenzione Oncologica -ISPO), it is necessary to send a few considerations and questions regarding the study design and the health data presented in the paper.…”

Authors’ response (August 21, 2017) to the letter to the Editor concerning the paper “Mortality for chronic-degenerative diseases in Tuscany: Ecological study comparing neighboring areas with substantial difference in environmental pollution”

“…Dear Editor, Judging by their first comment, Colleagues from the Cancer Research and Prevention Institute (Istituto per lo Studio e la Prevenzione Oncologica -ISPO) are likely to misinterpret the design of our study "Mortality for chronic-degenerative diseases in Tuscany: Ecological study comparing neighboring areas with substantial differences in environmental pollution" [1,2]. One of our aim actually was "to investigate the potential links between the possible excess in mortality rates and environmental release and detection of pollutants."…”

“…We are comforted to observe that, in the Table attached to the letter, the same mortality excesses are observed when the updated European reference population is used. With regard to the questions about the International Statistical Classification of Diseases and Related Health Problems, its 10th revision (ICD 10) defining the coding for ischemic heart diseases, our intention was to separate 2 all localizations (even if pleural forms were largely prevailing). As our study group includes clinical cardiologists, we are absolutely aware that mortality for ischemic heart diseases is heavily affected by differences in performance of acute illnesses care and, even more, by differences in behavioral risk factors (smoke, dietary habits, physical inactivity).…”