Mortality and hospitalization in contaminated sites with petrochemical and steel plants: a meta-regression ecological study.

BACKGROUND

Contaminated sites are among the main worldwide environmental health priorities. The health impact on population living in Italian contaminated sites of national concern for remediation (CSs) with petrochemical/refineries (P&R) and steel plants (S) was estimated. Since these CSs include the major Italian facilities located widespread on the territory are representative of the national reality. Furthermore, the population exposed in P&R and S is significant since it represents about 3% of the national population.

METHODS

Two groups of CSs were defined: twelve CSs with P&R and eight with S. Cause-specific mortality (2013-2017) and hospitalization (2014-2018) in both groups were analysed. Pooled Standardized Mortality/Hospitalization Ratios (SMR/SHR) were estimated through random-effect meta-regression of individual site SMR/SHR (reference: CS regional rate). The main groups of diseases and those for which the evidence of an association with the residential exposure to P&R and S was defined limited were analysed in adult while only the main groups of diseases were analysed in paediatric-adolescent and juvenile ages subgroups (0-1, 0-19, 20-29 years). All the analyses were performed separately for the two groups of CSs, and by sex.

RESULTS

In the two CSs groups, the overall and the main causes mortality and hospitalization, including all cancers, exceeded in both sexes. Specifically, for lung cancer in the P&R group, among males SMR=1.11 (CI90% 1.00-1.23) and SHR=1.18 (0.99-1.40) and among females SMR=1.13 (1.03-1.25) and SHR=1.20 (1.05-1.38), while in the S group, SMR=1.17 (1.02-1.34) and SHR=1.27 (0.87-1.86) among males and SMR=1.21 (0.93-1.59) and SHR=1.19 (0.91-1.57) among females. The mortality and hospitalization exceeded also for breast cancer in the P&R group. Hospitalization for leukaemia and respiratory diseases increased in the S group. In both CSs groups, among 20-29 years old sub-population, mortality for all tumours and hospitalization for respiratory diseases was worthy of note and hospitalization for all tumours exceeded among 0-1-year age-subgroup.

CONCLUSIONS

The results suggest that living in petrochemical/refineries and steel plants CSs is associated with increased risk for specific diseases. The meta-analytical estimates could contribute to assess the order of magnitude of health impacts of contaminated sites and to perform integrated evaluation of health and environmental impact.