• Daro Consonni1

  1. Clinica del lavoro, Milano
Dario Consonni -

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Ricerca bibliografica periodo dal 16 marzo 2012 al 30 maggio 2012

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Stringa: ((((((((("occupational exposure"[MeSH Terms] OR "occupational diseases"[MeSH Terms]) OR "occupational health"[MeSH Terms]) OR "workplace"[MeSH Terms]) OR "accidents, occupational"[MeSH Terms]) OR "employment"[MeSH Terms]) OR occupation[Title/Abstract]) OR occupational[Title/Abstract]) OR worker[Title/Abstract]) OR workers[Title/Abstract]) AND ("italy"[MeSH Terms] OR "italy"[All Fields]) AND ("2012/03/16"[PDAT] : "2012/05/30"[PDAT])
1. Kheiraoui F, Gualano MR, Mannocci A, Boccia A, La Torre G. Quality of life among healthcare workers: A multicentre cross-sectional study in Italy. Public Health. 2012 May 22. [Epub ahead of print]
Institute of Hygiene, Catholic University of the Sacred Heart, Rome, Italy.
OBJECTIVE To evaluate the quality of life among doctors, nurses, and occupational safety and health technologists (OSHT). STUDY DESIGN Cross-sectional study was undertaken in a population of healthcare workers in 10 Italian regions. METHODS The Italian version of Short Form-36 (SF-36) was anonymously and voluntarily self-administered by participants to assess the perceived health-related quality of life (HRQOL). The HRQOL scores for the sample and the Italian population were compared. A multiple linear regression was performed to assess the influence of age, gender, role, socializing time, working time, years spent in healthcare and years spent in the specific department on the SF-36 score. RESULTS The sample included 324 healthcare workers [57.1% women, mean age 39.0 (standard deviation 10.2) years]: 52.6% were medical doctors, 36.8% were nurses and 10.5% were OSHTs. Workers with a career of >15 years achieved a general health score lower than that of workers with a shorter career, while those who spent more time in socializing activities achieved a higher mental health score. The multivariate analysis showed that increasing age is positively related to role emotional levels (β = 0.243; P = 0.002), while it appears to be inversely related to general health (β = -0.218; P = 0.007) and physical function (β = -0.246; P = 0.001). Nurses had lower scores for bodily pain (β = -0.214; P < 0.001), social function (β = -0.242; P = 0.001) and role emotional (β = -0.211; P = 0.006) compared with doctors. Compared with the general Italian population, healthcare workers had higher scores for general health, physical function, role physical, bodily pain and mental health, and lower scores for vitality, social function and role emotional. CONCLUSIONS Healthcare workers have different levels of HRQOL related to their professional role. In particular, nurses have lower quality of life. These results may help to identify the main roles and attitudes that could cause frustration, dissatisfaction and emotional stress in healthcare workers.
2. Magnavita N, Fileni A, Pescarini L, Magnavita G. Violence against radiologists. I: prevalence and preventive measures. Radiol Med. 2012 May 14. [Epub ahead of print]
Istituto di Medicina del Lavoro, Università Cattolica del Sacro Cuore, Largo Gemelli 8, 00168, Roma, Italy,
PURPOSE Violence in the workplace is a specific risk for healthcare workers. Radiologists, especially when involved in emergency services, share that risk. Very few studies in the literature have researched this topic. This study aimed to evaluate the prevalence of violent behaviour in a large sample of Italian radiologists and analyse the phenomenon and its consequences with a view to proposing preventive measures. MATERIALS AND METHODS A total of 992 radiologists (61.5% men) taking part in a national radiology congress agreed to respond to a questionnaire on violence that contained the Violent Incident Form by Arnetz for the description of violent incidents in healthcare practice. RESULTS Some 6.8% of radiologists in public hospitals experienced physical abuse in the previous 12 months, for the most part from patients or their companions. The prevalence of physical abuse is greatest among younger healthcare individuals with less clinical experience, with no differences between sexes. Among younger radiologists, one in five suffered at least one act of physical abuse in a working year. Nonphysical violence is more widespread and throughout radiologists' working lives affects 65.2% of them. In this case, almost half of the violent incidents originate from colleagues. A total of 5.5% of respondents stated that they were victims of abuse at the time of the survey. In most cases, the violent incidents remain unreported. The immediate consequences of violence in the workplace are emotions such as anger, disappointment, humiliation, anxiety, fear, distress, a feeling of helplessness and isolation, occasionally a feeling of guilt or of having done wrong and a desire to take revenge, change behaviour or change workplace. CONCLUSIONS The extent of the problem calls for the adoption of a series of measures aimed at eliminating the causes of the various forms of workplace violence.
3. Magnavita N, Fileni A. Violence against radiologists. II: psychosocial factors. Radiol Med. 2012 May 14. [Epub ahead of print]
Istituto di Medicina del Lavoro, Università Cattolica del Sacro Cuore, Largo Gemelli 8, 00168, Roma, Italy,
PURPOSE Violence against radiologists is a growing problem. This study evaluated the psychosocial factors associated with this phenomenon. MATERIALS AND METHODS A questionnaire was administered to 992 Italian radiologists. RESULTS Physical violence experienced in the previous 12-month period was associated with the radiologist's poor mental health [odds ratio (OR) 1.11] and overcommitment to work (OR 1.06), whereas radiologists in good physical health (OR 0.64), with job satisfaction (OR 0.96) and with overall happiness (OR 0.67) were less exposed. Nonphysical abuse was equally associated with the radiologist's poor mental health (OR 1.10) and overcommitment (OR 1.14) and negatively associated with physical health (OR 0.54), job satisfaction (OR 0.96), happiness (OR 0.81), organisational justice (OR 0.94) and social support (OR 0.80). CONCLUSIONS Preventive intervention against violence in the workplace should improve workplace organisation and relationships between workers.
4. Rui F, Bovenzi M, Prodi A, Belloni Fortina A, Romano I, Corradin MT, Larese Filon F. Concurrent sensitization to metals and occupation. Contact Dermatitis. 2012 May 12. doi: 10.1111/j.1600-0536.2012.02100.x. [Epub ahead of print]
Clinical Unit of Occupational Medicine, Department of Medical Sciences, University of Trieste, Trieste 34129, Italy Dermatology Unit, Department of Pediatrics, University of Padova, Padova 35128, Italy Dermatologic Unit, S. Maria degli Angeli Hospital, Pordenone 33170, Italy.
BACKGROUND Cosensitization to nickel, cobalt and chromium occurs in the general population and in some occupational groups. OBJECTIVES To estimate the isolated and concurrent occurrence of nickel, cobalt and chromium contact sensitization and their association with individual and occupational risk factors. PATIENTS/METHODS Twelve thousand four hundred and ninety-two patients were patch tested with the European baseline series between 1997 and 2004 in north-eastern Italy. The associations between patch test results and patient characteristics and occupations were investigated by means of multinomial logistic regression analysis. RESULTS Of the patients, 34.7% (4334 patients) had one or more positive patch test reactions to metals. As compared with those with negative reactions to all three metals, nickel sensitization was significantly higher in females than in males, not only as monosensitization, but also as cosensitization with cobalt, with chromium, or with both metals. Building and related trades workers showed positive reactions to chromium + nickel [odds ratio (OR) 1.99; 95% confidence interval (CI) 1.05-3.76) and chromium + cobalt (OR 2.61; 95% CI 1.46-4.67]. Cleaning workers showed a high prevalence of nickel, chromium, nickel + chromium and nickel + cobalt + chromium cosensitization (ORs 1.29, 1.66, 2.11, and 1.79, respectively). An excess risk for cosensitization to all three metals was found in textile and leather workers (OR 2.19; 95% CI 1.10-4.33), and in bartenders (OR 2.10; 95% CI 1.03-4.26). CONCLUSIONS Some occupational groups are more likely to develop nickel, cobalt and chromium cosensitization.
5. Sancini A, Tomei G, Vitarelli A, Caciari T, Samperi I, Pacchiarotti A, Scala B, Schifano MP, Scimitto L, Fiaschetti M, Cetica C, Tomei F, Ciarrocca M. Cardiovascular risk in rotogravure industry. J Occup Environ Med. 2012 May;54(5):551-7.
Unit of Occupational Medicine, University of Rome Sapienza, Rome, Italy.
OBJECTIVE To verify whether the occupational hazards in the rotogravure industry can be associated with cardiovascular effects. METHODS We evaluated cardiovascular parameters and audiometric tests and analyzed noise, solvents, and shift work in 44 exposed and 44 unexposed workers. RESULTS Unlike unexposed workers, the rotogravure workers showed significant increase of mean systolic and diastolic blood pressure (BP) values (P = 0.019; P = 0.003), higher frequency of hypertension (P = 0.002) and electrocardiographic abnormalities (P = 0.0001), significant reduction or no variation of BP response to orthostatism (P = 0.0001), and association between high levels of noise and diastolic blood pressure (P = 0.0067). Subjects with hearing loss showed high frequency of hypertension and a reduction or no variation of BP response to orthostatism (both P = 0.05). CONCLUSIONS Data obtained suggest that these are the effects on the cardiovascular system of rotogravure workers who are exposed to noise.
6. Manuela C, Francesco T, Tiziana C, Assunta C, Lara S, Nadia N, Giorgia A, Barbara S, Maria F, Carlotta C, Valeria DG, Pia SM, Gianfranco T, Angela S. Environmental and biological monitoring of benzene in traffic policemen, police drivers and rural outdoor male workers. J Environ Monit. 2012 May 30;14(6):1542-50. Epub 2012 May 3.
University of Rome "Sapienza", Department of Anatomy, Histology, Medical-Legal and the Orthopedics, Unit of Occupational Medicine, Viale Regina Elena 336, 00161 Rome, Italy.
To evaluate exposure to benzene in urban and rural areas, an investigation into personal exposure to benzene in traffic policemen, police drivers and rural (roadmen) male outdoor workers was carried out. Personal samples and data acquired using fixed monitoring stations located in different areas of the city were used to measure personal exposure to benzene in 62 non-smoker traffic policemen, 22 police drivers and 57 roadmen. Blood benzene, urinary trans-trans muconic acid (t,t-MA) and S-phenyl-mercapturic acid (S-PMA) were measured at the end of work shift in 62 non-smoker traffic policemen, 22 police drivers and 57 roadmen and 34 smoker traffic policemen, 21 police drivers and 53 roadmen. Exposure to benzene was similar among non-smoker traffic policemen and police drivers and higher among non-smoker urban workers compared to rural workers. Blood benzene, t,t-MA and S-PMA were similar among non-smoker traffic policemen and police drivers; blood benzene and t,t-MA were significantly higher in non-smoker urban workers compared to rural workers. Significant increases in t,t-MA were found in smokers vs. non-smokers. In non-smoker urban workers airborne benzene and blood benzene, and t,t-MA and S-PMA were significantly correlated. This study gives an evaluation of the exposure to benzene in an urban area, comparing people working in the street or in cars, to people working in a rural area. Benzene is a certain carcinogen for humans. The results we showed should lead to more in-depth studies about the effects on health of these categories of workers.
7. Magnavita N, Heponiemi T. Violence towards health care workers in a Public Health Care Facility in Italy: a repeated crosssectional study. BMC Health Serv Res. 2012 May 2;12(1):108. [Epub ahead of print]
BACKGROUND Violence at work is one of the major concerns in health care activities. The aim of this study was to identify the prevalence of physical and non-physical violence in a general health care facility in Italy and to assess the relationship between violence and psychosocial factors, thereby providing a basis for appropriate intervention. METHODS All health care workers from a public health care facility were invited to complete a questionnaire containing questions on workplace violence. Three questionnaire-based crosssectional surveys were conducted. The response rate was 75 % in 2005, 71 % in 2007, and 94 % in 2009. The 2009 questionnaire contained the VIF (Violent Incident Form) for reporting violent incidents, the DCS (demand/control/support) model for job strain, the Colquitt 20 item questionnaire for perceived organizational justice, and the GHQ12 General Health Questionnaire for the assessment of mental health. RESULTS One out of ten workers reported physical assault, and one out of three exposure to nonphysical violence in the workplace in the previous year. Nurses and physicians were the most exposed occupational categories, whereas the psychiatric and emergency departments were the services at greatest risk of violence. Workers exposed to non-physical violence were subject to high job strain, low support, low perceived organizational justice, and high psychological distress. CONCLUSIONS Our study shows that health care workers in an Italian local health care facility are exposed to violence. Workplace violence was associated with high demand and psychological disorders, while job control, social support and organizational justice were protective factors.
8. Marinaccio A, Scarselli A, Merler E, Iavicoli S. Mesothelioma incidence surveillance systems and claims for workers' compensation. Epidemiological evidence and prospects for an integrated framework. BMC Public Health. 2012 Apr 30;12(1):314. [Epub ahead of print]
Occupational Medicine Department, INAIL (Italian Workers Compensation Authority) research area, Italian National Mesothelioma Register (ReNaM), Via Alessandria 220, Rome, 00198, Italy.
BACKGROUND Malignant mesothelioma is an aggressive and lethal tumour strongly associated with exposure to asbestos (mainly occupational). In Italy a large part of workers are protected from professional diseases by public insurance and it is active an epidemiological surveillance system for incident mesothelioma cases. METHODS We set up an individual linkage between the Italian national mesothelioma register (ReNaM) and the Italian workers' compensation authority (INAIL) archives. Logistic regression models were used to identify and test explanatory variables. RESULTS We extracted 3270 mesothelioma cases with occupational origins from the ReNaM, matching them with 1625 subjects in INAIL (49.7%); 91.2% (1,482) of the claims received compensation. The risk of not seeking compensation is significantly higher for women and old people. Claims have increased significantly in recent years and there is a clear geographical gradient (northern and more developed regions having higher claims rates). The highest rates of compensation claims were after work known to involve asbestos. CONCLUSIONS Our data illustrate the importance of documentation and dissemination of all asbestos exposure modalities. Strategies focused on structural and systematic interaction between epidemiological surveillance and insurance systems are needed.

Breve commento a cura di Dario Consonni
Questo importante articolo mostra che, nonostante alcuni miglioramenti negli anni più recenti, la mancata compensazione di molti soggetti affetti da mesotelioma rimane ancora un problema.

9. Ropolo M, Balia C, Roggieri P, Lodi V, Nucci MC, Violante FS, Silingardi P, Colacci A, Bolognesi C. The micronucleus assay as a biological dosimeter in hospital workers exposed to low doses of ionizing radiation. Mutat Res. 2012 Aug 30;747(1):7-13. Epub 2012 Apr 14.
Environmental Carcinogenesis Unit, IRCCS Azienda Ospedaliera Universitaria San Martino -IST, Istituto Nazionale Ricerca sul Cancro, Largo R. Benzi 10, 16132, Genova, Italy.
The health risk associated with low levels of ionizing radiation is still a matter of debate. A number of factors, such as non-target effects, adaptive responses and low-dose hypersensitivity, affect the long-term outcome of low-dose exposures. Cytogenetic bio-dosimetry provides a measure of the absorbed dose, taking into account the individual radiation sensitivity. The aim of the present study is to evaluate the value of the micronucleus (MN) test as a bio-dosimeter in hospital workers exposed to low doses of ionizing radiation. Blood samples were obtained from 30 subjects selected among workers exposed to X- and gamma-radiation, and 30 controls matched for sex, age and smoking from the same hospital. Micronucleus frequencies were analyzed by use of the cytokinesis-block method. The MN frequency was compared among the groups considering the confounding factors and the length of employment. No increase in the number of bi-nucleated cells with MN (BNMN), but a significant increase in the number of mono-nucleated cells with micronuclei (MOMN) was observed in exposed subjects compared with the controls. The relationship between MN frequency and accumulated dose (mSv) was evaluated. The length of employment did not affect the extent of MN frequency, but an increase of BNMN and MOMN cells was observed based on the accumulated radiation dose. Our study shows the sensitivity of the MN test in the detection of cytogenetic effects of cumulative exposure levels, suggesting the potential usefulness of this assay in providing a biological index in medical surveillance programs.
10. Mazzucco W, Lacca G, Cusimano R, Provenzani A, Costa A, Di Noto AM, Massenti MF, Leto-Barone MS, Lorenzo GD, Vitale F. Prevalence of sensitization to Anisakis simplex among professionally exposed populations in Sicily. Arch Environ Occup Health. 2012 Apr;67(2):91-7.
Dipartimento Scienze Promozione della Salute-Sezione Igiene, University of Palermo, Palermo, Italy.
Anisakis simplex (AS) is a cause of allergic sensitization and potential occupational risk is suggested in fishermen and workers assigned to fish processing and sale. A cross-sectional study was conducted in order to assess possible health effects of occupational exposure to AS in workers recruited from western Sicily fisheries sector. Social, demographic, and occupation-related data were collected. Serum total immunoglobulin E (IgE) and specific IgE levels to AS (threshold >0.35 kU/L) were determined by an fluoroimmunoassay technique. Ninety-four subjects with potential occupational exposure (fishmongers, fishermen, fish industry employees) were recruited. Specific AS IgEs were detected in 20.2% of the study population. AS IgE seroprevalence was elevated 6.7-fold (p = .03) among fishermen/sailors compared with fish industry workers. The study suggested the importance to adopt specific prevention strategies against exposure to AS in the occupational setting.
11. Li Ranzi T, d'Errico A, Costa G. Association between chronic morbidity and early retirement in Italy. Int Arch Occup Environ Health. 2012 Apr 3. [Epub ahead of print]
Local Health Unit ASL TO3, Epidemiology Department, Piedmont Region, Via Sabaudia 164, 10095, Grugliasco, TO, Italy,
OBJECTIVES To examine the association between early retirement and presence of chronic morbidity in an Italian working population approaching the statutory pension age. METHODS The study population consisted of men and women aged 45-59 years, employed at some time in the past (n = 18,547), who participated in a national cross-sectional survey, conducted in 2005. By means of a standardized questionnaire, information was collected on employment status, chronic diseases, and sociodemographics. The outcome was being retired as of the survey date. The association with number of diseases reported and specific long-term illnesses was assessed through multivariate Poisson regression models with robust standard errors, adjusted for potential confounders (p < 0.05). RESULTS In the final multivariable models, people with poorer health were more likely to retire earlier. Diseases of the nervous system, malignant tumors, myocardial infarction, other cardiac diseases, and arthrosis/arthritis were the illnesses most strongly associated with early retirement; furthermore, the risk of retirement increased linearly as the number of diseases reported increased. Among other covariates, age, area of residence, educational level, and occupational social class were also significantly associated with the outcome. Occupational social class significantly modified the association between morbidity and retirement in men, among whom a higher risk of retirement associated with morbidity was observed in the highest, compared with lower social classes. CONCLUSIONS A statistically significant and independent association between chronic morbidity and early retirement was observed among subjects approaching the statutory pension age, suggesting the need to develop interventions to improve prevention and treatment of chronic conditions.
12. De Matteis S, Consonni D, Lubin JH, Tucker M, Peters S, Vermeulen RC, Kromhout H, Bertazzi PA, Caporaso NE, Pesatori AC, Wacholder S, Landi MT. Impact of occupational carcinogens on lung cancer risk in a general population. Int J Epidemiol. 2012 Mar 31. [Epub ahead of print]
Unit of Epidemiology, Department of Preventive Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico and EPOCA Research Centre, Department of Occupational and Environmental Health, Università degli Studi di Milano, Milan, Italy, Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Bethesda, MD, USA and Institute for Risk Assessment Sciences, Environmental Epidemiology Division, Utrecht University, Utrecht, The Netherlands.
BACKGROUND Exposure to occupational carcinogens is an important preventable cause of lung cancer. Most of the previous studies were in highly exposed industrial cohorts. Our aim was to quantify lung cancer burden attributable to occupational carcinogens in a general population. METHODS We applied a new job-exposure matrix (JEM) to translate lifetime work histories, collected by personal interview and coded into standard job titles, into never, low and high exposure levels for six known/suspected occupational lung carcinogens in the Environment and Genetics in Lung cancer Etiology (EAGLE) population-based case-control study, conducted in Lombardy region, Italy, in 2002-05. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated in men (1537 cases and 1617 controls), by logistic regression adjusted for potential confounders, including smoking and co-exposure to JEM carcinogens. The population attributable fraction (PAF) was estimated as impact measure. RESULTS Men showed an increased lung cancer risk even at low exposure to asbestos (OR: 1.76; 95% CI: 1.42-2.18), crystalline silica (OR: 1.31; 95% CI: 1.00-1.71) and nickel-chromium (OR: 1.18; 95% CI: 0.90-1.53); risk increased with exposure level. For polycyclic aromatic hydrocarbons, an increased risk (OR: 1.64; 95% CI: 0.99-2.70) was found only for high exposures. The PAFs for any exposure to asbestos, silica and nickel-chromium were 18.1, 5.7 and 7.0%, respectively, equivalent to an overall PAF of 22.5% (95% CI: 14.1-30.0). This corresponds to about 1016 (95% CI: 637-1355) male lung cancer cases/year in Lombardy. CONCLUSIONS These findings support the substantial role of selected occupational carcinogens on lung cancer burden, even at low exposures, in a general population.
13. De Palma G, Poli D, Manini P, Andreoli R, Mozzoni P, Apostoli P, Mutti A. Biomarkers of exposure to aromatic hydrocarbons and methyl tert-butyl ether in petrol station workers. Biomarkers. 2012 Jun;17(4):343-51. Epub 2012 Mar 29.
Department of Experimental and Applied Medicine, Occupational Medicine and Industrial Hygiene, University of Brescia , Brescia , Italy.
This cross-sectional study was aimed at reconstructing the exposure to gasoline in 102 petrol station attendants by environmental and biological monitoring of benzene, toluene, ethylbenzene and xylene (BTEX) and biomonitoring of methyl tert-butyl ether (MTBE). Airborne BTEX were higher for manual refuelers than self-service assistants and were highly correlated with each other. Significant relationships were found between airborne BTX and the corresponding urinary solvents (U-BTX) and beween airborne B and urinary MTBE (U-MTBE). Smokers eliminated higher values of U-B, trans,trans-muconic (t,t-MA) and S-phenylmercapturic (S-PMA) acids but not U-MTBE. All these biomarkers were, however, significantly raised during the shift, independently from smoking. Linear regression confirmed that occupational exposure was a main predictor of U-MTBE, U-B and S-PMA values, both the latter confounded by smoking habits. The study supports the usefulness of biomonitoring even at low exposure levels.
14. Mattioli S, Farioli A, Cooke RM, Baldasseroni A, Ruotsalainen J, Placidi D, Curti S, Mancini G, Fierro M, Campo G, Zanardi F, Violante FS. Hidden effectiveness? Results of hand-searching Italian language journals for occupational health interventions. Occup Environ Med. 2012 Jul;69(7):522-4. Epub 2012 Mar 23.
Alma Mater Studiorum, University of Bologna, Unità Operativa di Medicina del Lavoro, Policlinico S.Orsola-Malpighi, Via Pelagio Palagi 9, 40138 Bologna, Italy;
OBJECTIVE To compare the yield of hand-searching with optimised electronic search strategies in retrieving occupational health (OH) intervention studies published in a language other than English. METHODS The authors systematically hand-searched and screened reports of OH intervention studies published in Italian in peer-reviewed scientific journals between 1990 and 2008. The authors evaluated how many of them met the Cochrane Occupational Safety and Health Review Groups (OSHRG) definition of being an OH intervention study and how many potentially relevant studies retrieved by hand-searching would not be found by PubMed alone using the OSHRG's most specific and most sensitive search strings. RESULTS Hand-searching retrieved 25 articles (reporting 27 studies), including nine not indexed in MEDLINE. Most studies (81%, 22/27) had a before-after design and only one was a randomised trial. The OSHRG's most sensitive search string retrieved all 16 articles published in the Italian language journals that were indexed in MEDLINE, while the most specific search strategy retrieved nine articles (56%, 9/16). The most specific search string showed a lower 'number needed to read' value than the most sensitive one (60 vs 132). CONCLUSIONS These findings suggest that a sensitive electronic search strategy may be able to find most of the OH interventions published in languages other than English that are indexed in MEDLINE. Hand-searching of important national journals not indexed in MEDLINE should be considered when conducting particularly in-depth research. PMID: 22447642 [PubMed - in process]
15. Frullanti E, La Vecchia C, Boffetta P, Zocchetti C. Vinyl chloride exposure and cirrhosis: A systematic review and meta-analysis. Dig Liver Dis. 2012 Mar 20. [Epub ahead of print]
Department of Predictive and Preventive Medicine, Fondazione IRCCS, Istituto Nazionale Tumori, Milan, Italy.
BACKGROUND It has been proposed that vinyl chloride exposure is associated with increased risk of death from cirrhosis, although epidemiologic evidence is limited. METHODS We analyzed the risk of death from cirrhosis by occupational vinyl chloride exposure by conducting a meta-analysis on seven available studies, including more than 40,000 workers exposed to vinyl chloride mostly in North America and Europe, with a total of 203 deaths from cirrhosis. RESULTS All epidemiological studies on vinyl chloride exposure and risk of death from cirrhosis resulted in an overall relative risk of 0.73 (95% confidence interval 0.61-0.87). Thus, the epidemiologic evidence does not suggest an excess mortality from cirrhosis in vinyl chloride-exposed workers; this is consistent with histopathological observations in livers of angiosarcoma patients and of vinyl chloride-exposed rodents revealing no signs of cirrhosis. CONCLUSION Overall, our findings indicate the absence of increased risk of death from cirrhosis in vinyl chloride-exposed workers.

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