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

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 PM2.5 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 PM2.5 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.

Chronos, Kairos, and the environmental control against radon

“…The recent availability of pollution exposure data with high geographical resolution in Italy has prompted the construction of a multivariate statistical model for estimating lung cancer mortality by predictors in the context of ecological design. The data demonstrate the central significance of environmental factors in lung cancer risk (Borgoni et al , 2011; Maggiore et al , 2020; Gariazzo et al , 2021; Voltattorni et al , 2023). Identifying environmental and occupational lung cancer risk factors is vital for enhancing understanding of the disease's origin, hence increasing the fairness of the welfare system.…”