Malignant mesothelioma and asbestos exposure in Europe: Evidence of spatial clustering.

Exposure to asbestos causes a wide range of diseases, such as asbestosis, malignant mesothelioma (MM) and other types of cancer. Many European countries have reduced production and use of asbestos and some have banned it altogether. Based on data derived from the World Health Organisation (WHO) Cancer Mortality Database, we investigated whether some regions in Europe could have a higher relative risk of MM incidence than others. The data were compared, including the number of MM deaths per million inhabitants and aged-standardized mortality rates. Applying Moran's I and Getis-Ord Gi statistic on the agedstandardized mortality rates of MM cases assisted the spatial analysis of the occurrence of health events leading to an assessment of the heterogeneity of distribution and cluster detection of MM. We found a statistically significant positive autocorrelation for the male population and also the general population, while there was no statistically significant positive one for the female population. Hotspots of relative risk of developing MM were found in northwestern Europe. For the general population, Great Britain and the Netherlands stood out with high levels at the 99% and 95% confidence levels, respectively. For the male population, the results were similar, but with addition of risk also in Belgium and Switzerland. However, in many European countries with high asbestos use per capita, the MM incidence was found to still be low. The reasons for this are not yet clear, but part of the problem is certainly due to incomplete data in registers and databases. The latency time can be longer than 40 years and is related to the intensity and time of exposure (occupational, para-occupational and environmental). In Europe, even though peak production occurred in the 1960s and 1970s, a significant decrease in production did not occur until 25 years later, which means that the impact will continue for as late as The mid 2030s.

Reply to Comment on Malgorzata Krówczynska and Ewa Wilk. Environmental and Occupational Exposure to Asbestos as a Result of Consumption and Use in Poland. Int. J. Environ. Res. Public Health 2019, 16, 2611.

Thank you for the possibility of enabling us to provide a response to the comment on our paper "Environmental and Occupational Exposure to Asbestos as a Result of Consumption and Use in Poland" [...].

Environmental and Occupational Exposure to Asbestos as a Result of Consumption and Use in Poland.

Asbestos is harmful to human health; exposure to asbestos causes a wide range of asbestos-related diseases. AIM: Malignant mesothelioma (MM) is unique to occupational and environmental asbestos exposure. METHODS: Environmental asbestos exposure was examined in relation to asbestos use and manufacturing, the quantity of the asbestos-containing products still in use, the concentrations of asbestos fibres in the air and the number of MM cases diagnosed each year per county. RESULTS: The correlation coefficient of the measurements of the asbestos fibre concentrations in the air and the quantity of asbestos-cement products in use is high and amounts to 0.68. Meanwhile, the correlation coefficient of the measurements of asbestos fibre concentrations in air and MM morbidity rate resulting from environmental exposure calculated for particular counties in provinces is low and amounts to 0.37. The highest MM morbidity rate was observed for Malopolskie and Slaskie, a typical industrial area of Poland. CONCLUSIONS: There are MM cases which are still attributable to occupational asbestos exposure, although MM cases resulting from environmental exposure to asbestos have an increased MM risk. Poland is among those countries with a low MM incidence rate, which seems to be an underestimation of environmental asbestos exposure. As long as asbestos-cement products are used in the environment, actions should be undertaken to protect public health.

Spatial analysis of asbestos exposure and occupational health care in Poland during the period 2004-2013.

Asbestos is carcinogenic to humans and exposure to this substance can cause a wide range of diseases. In Poland 1997, a statutory ban was introduced on the production, use and marketing of products containing asbestos. The National Programme for Asbestos Abatement for 2009-2032 includes scheduled activities considering asbestos exposure assessment and health protection. As there are several data sources for asbestos exposure in Poland, which are not linked, the aim of this study was to gather and order them developing a PostgreSQL database, an open-source, objectrelational system. The data gathered combines the following information: the quantity of asbestos-cement products in use, details of asbestos manufacturing plants, the results of the measurements of asbestos fibre concentrations in the air and cases of asbestos-related diseases. The relational database was then used to develop a spatial analysis of asbestos monitoring and exposure in Poland to demonstrate the current state of realisation of the National Asbestos Abatement Programme in the country for 2009-2032 with the use of geoinformation techniques. The use of a database on health aspects of occupational and environmental asbestos exposure was also proposed in Asbestos, Asbestosis, and Cancer: Helsinki Criteria update 2014.

Pleural mesothelioma in Poland: Spatial analysis of malignant mesothelioma prevalence in the period 1999-2013.

Malignant mesothelioma (MM), a rare and very deadly tumour, can be due to asbestos exposure. To better understand the cause of incidence of MM, spatial autocorrelation analysis with reference to the quantity of asbestos-cement products in use and the localisation of former asbestos manufacturing plants was applied. Geostatistical analysis shows that strong spatial clustering of MM incidence (referring to the general population as well as females and males separately) during the period 1999-2013 in the administrative units of Poland (provinces and counties). Incidence hotspots were found to be concentrated primarily in southern Poland but also seen in the county of Szczecin, which stands out in local autocorrelation analysis in north-western Poland. High incidence rates were discovered, in particular with reference to counties around former plants manufacturing asbestos-containing products, mainly asbestos-cement manufacturers. The highest frequency of MM incidence rate was found in within a 55 km radius of plants in or near the towns Trzebinia, Ogrodzieniec and Szczucin in the South, where asbestos-cement products had been manufactured for close to 40 years. Areas with significantly high incidence rates were also discovered in the provinces of Slaskie, Malopolskie and Swietokrzyskie in southern Poland.

Asbestos Exposure and the Mesothelioma Incidence in Poland.

Asbestos is carcinogenic to humans; the exposure to asbestos causes a wide range of diseases. AIM: Malignant mesothelioma (MM) is unique for asbestos exposure. METHODS: Based on the physical inventory of asbestos-cement roofing, the social-economic situation of communes, the proximity of asbestos manufacturing plants, the land use data referring to the surface of the built-up area, and the historical data on the annexations, the amount of asbestos-containing products in use was estimated by computing best Random Forest models. Per capita asbestos use is an indicator to compare the state of asbestos use among countries. MM cases in the local administrative units (provinces) were tested by the application of Moran's I and Getis and Ord statistic. RESULTS: The total amount of asbestos roofing in Poland was estimated at 738,068,000 m² (8.2 million tons). In total there were 28 plants in Poland located in 11 provinces throughout the country. The amount of asbestos-cement roofing in use is correlated primarily with the measurements of asbestos concentration fibers (rs = 0.597). MM raw morbidity rate was calculated, stratified by province, and classified into five groups with respect to incidence. Hotspots of MM cases are in the southern part of Poland. CONCLUSIONS: MM cases are concentrated in the same geographical areas, which may indicate an increasing impact of environmental exposure. The results of the local and global autocorrelation clearly indicate a statistically significant relationship between incidences of MM in provinces. Poland and other Eastern European countries are among countries with low MM incidence rate. Detailed investigation is desirable since the current MM morbidity rate in Poland seems to be underestimated.

Estimation of the amount of asbestos-cement roofing in Poland.

The unique set of physical and chemical properties has led to many industrial applications of asbestos worldwide; one of them was roof covering. Asbestos is harmful to human health, and therefore its use was legally forbidden. Since in Poland there is no adequate data on the amount of asbestos-cement roofing, the objective of this study was to estimate its quantity on the basis of physical inventory taking with the use of aerial imagery, and the application of selected statistical features. Data pre-processing and analysis was executed in R Statistical Environment v. 3.1.0. Best random forest models were computed; model explaining 72.9% of the variance was subsequently used to prepare the prediction map of the amount of asbestos-cement roofing in Poland. Variables defining the number of farms, number and age of buildings, and regional differences were crucial for the analysis. The total amount of asbestos roofing in Poland was estimated at 738,068,000 m2 (8.2m t). It is crucial for the landfill development programme, financial resources distribution, and application of monitoring policies.

[Use of prenatal health care and risk of infants born small-for-gestational-age. Preliminary results of a case-control study in the Lódz voivodeship]. / Profil korzystania z opieki prenatalnej a ryzyko hipotrofii plodu. Wstepne wyniki badania kliniczno-kontrolnego w woj. lódzkim.

It is well documented that small-for-gestational age (SGA) infants are at an increased risk of perinatal mortality and morbidity. In order to identify the major modifiable risk factors of SGA birth, a case-control study was launched in the area of Lódz voivodeship, Poland. The project was focused on the evaluation of the role of perinatal health services and avoidance of exposure to tobacco smoke in the prevention of SGA births. The study population consisted of mothers of 153 SGA infants (cases) and 93 mothers of control infants. SGA infants were identified as infants with body weight below 10th percentile for gestational age, using Ballarda scale. The controls were non-SGA infants delivered after 37 week of gestation. The infants from both groups were delivered in 26 maternity wards in the Lódz voivodeship within the period of June 1-November 1, 2003. One month after delivery, each mother of SGA and control infants was visited by an interviewer who collected information about her profile of use of perinatal health care and on active and passive exposure to tobacco smoke in pregnancy. Odds ratios and 95% confidence units (CU) were calculated using EpiInfo software developed by CDC, Atlanta, Georgia, US. Late booking for perinatal care (after 12 week of gestation) and less than 5 visits during pregnancy was found to be related to an increased risk of SGA, however, the OR values included unity. About 1/3 of mothers of SGA infants and "of the controls were served mainly by the private health sector. The use of private care was related to a lower risk of SGA: OR= 0.55 95% CI (0.31-0.96). This protective pattern was observed in the population of women aged 19-25 living in rural areas years and with only primary education. The preconception visits to obstetricians and contacts with health educators during pregnancy were also found to have some protective effect, however, the ORs were not statistically significant. The adverse effect of smoking during pregnancy was clearly confirmed in the study population, OR= 2.69 95%CI (1.37-5.33), while the role of passive smoking was difficult to assess due to the small number of nonsmoking women exposed to ETS. There are some indications that the poor use of perinatal health services may account for the elevated risk of SGA births in the Lódz voivodeship. The use of the private health sector is growing and seems to be related to a lower risk of SGA births. More effective tools to prevent maternal smoking have to be developed and implemented in routine perinatal care.