1 15 2 https://www.nal.usda.gov/exhibits/speccoll/files/original/6668260c8540d1f879895f3a9dc71b06.pdf f0ea474860bff3574a152f942225f20c PDF Text Text Item D Number 02417 Author Apricena, Matteo Corporate Author RODOrt/ArtidO TItiB Typescript: Survey of Mortality in the Seveso Area: 1975-1981 Journal/Book Title Yeer 000 ° Month/Day Color 0 Number of Images 11 Deecnptm Notes Friday, October 05, 2001 Page 2417 of 2422 �SURVEY OF MORTALITY BF THE SEVESO AREA 1975-1981 — Mr. Matteo Apricena (Special Department) - Dr. Luigi Falliva (Special Department) - Dr Rcsella Gnioldi (Special Department) - Dr Riccardo Puntoni (Cancer Institute-Genoa) - Dr Eraanuele Stagnaro (Cancer InstitLite—Genoa) - Dr Marina Vercelli (Cancer Institute-Genoa) Coordinators: - Prof. Leonardo Santi (Cancer Institute-Genoa) - Dr Giulio Doricotti (until 30/6/32) - Dr Luigi Meaasa (since 30/6/82) �STUDY OF MORTALITY IN THE SEVESO AREA (1975-1981) In previous mortality surveys we emphasised several times the problems arising from the characteristics of the reports presented, both positive and negative. The first survey, done at Communal level in the period 197579, presented serious limitations in regard to use of the data for an assessment of the damage attributable to the ICMESA accident. This was because of the characteristics of the population under study defined only on administrative criteria: the residents in each Commune. In the second survey deaths were distributed between zones A, 3 and R. This study, though more concretely related to the potential risk of exposure to dioxin, presented limitations due to the mobility of people, limitations due to the use of the dioxin present in the soil as sole potential indicator of risk. This version, updated to 1981, gives the data processed in a third way, in order to arrive at further, more precise indications on the possible correlation between the accident of July 1976 and the specific mortality rates by sex, age and cause in the following years. This study is divided into three parts: one using as denominators the inhabitants of each of the 11 Communes; one with the residents in zones A, B, R and one breaking down the population into 6 belts from 31 to S6 (see figure). The definition of these belts is at present at a preliminary stage and is based mainly on the cases of chloracne and of acute skin lesions that occurred in every square with a side of about ~T km in the whole area under study. The division into belts is not at all final �events occurring- in tlie area under study. Tl'.e definition of tliese rislc areas is still under study and a preliminary version should emerge by tiie end of t2ie year. In addition to the definition of the exposed, that is the denominator necessar3/r for the calculation of rates, there "/as -the problem of the numerators, that is the definition of the causes of death . For the period. 1975-1 979 all the causes (?3%v' ?/ere of course traced ex post by ISTAT personnel in P.ome. These data have already been coded by the ISTAT personnel. all the causes of death have been traced, of ISTAT, at the 11 Communes. From 10 of photostats of ISTAT form D4/D5 '.vhile from to get only transcriptions. Since 1 January i93C "'ith the authorisation them vs have obtained one we have been able In the case of deaths occurring outside the 11 Communes rve are notified only of the place of death and periodically, by "/riting to the offices of the Commune in "/hich death occurred, it has been possible to retrieve information on the cause of death. The information for the entire ceriod is no~* over 59/= complete. Since January 19SC the coding of the causes of death has been handled by our personnel 'l epidemiologist!1, "*ho codes all three causes of death. �Our analysis of the data yielded some differences between the two periods, in our view to be attributed to a different criterion of definition of the cause of death first diagnosed. These doubts are stated in the text when these criteria are thought to have altered the trend. The causes of death have been grouped in 55 categories as per attached list. At this stage of the survey we were still tied to citizens' residence and so it is not yet a cohort study but a survey of mortality on citizens resident each year in the areas reported (communes, zones, belts). The next version of the survey would logically be targeted on citizens resident on 10 July 1976, excluding immigrants and retrieving information on emigrants. The present study gives the crude and standardised rates in each commune, zone and belt by cause of death, sex, age-group and year of death. We have also calculated the expected rates on the basis of the mortality both in the zones outside R and in the belts considered blank (S_+Sg) for the purpose of internal comparison. The causes of death are stated in detail in the attached tables The population resident each year in the area has been reconstructed through the Special Department computer, which stores the registry office data for all 220 000 residents, including births, deaths and changes of address. In the attached printout the population is broken down by commune, zone and belt for each year. �Comment on the tables INFECTIVE AND PARASITIC DISEASES (000-136, A1-A44). There are no significant increases through time or differences between communes, zones or belts . ALL TUMORS (140-239, A45-A61)(including benign). The rate ranges from 207 cases per 100 000 inhabitants in 1978 to 246 in 1982 in males and from 131 in 1977 to 175 cases in 1981 in females. The general trend is upward within the limits expected for the Italian population. There are no noteworthy differences by commune, zone or belt. ENDOCRINE, NUTRITIONAL AND METABOLIC DISEASES EXCLUDING DIABETES MELLITUS (240-246, 251-279, A62-A63, A65-A66) - No noteworthy differences. DIABETES MELLITUS (250, A64) - There is a noteworthy increase in the years 1980-81. In our'view, the difference is largely due to an overestimate compared to ISTAT because from 1980 onwards the disease codes have been applied by our epidemiologists, who have always regarded diabetes, when present with other cardiovascular causes, as the primary cause of death, as in fact was indicated by the ISTAT coders. The rates from 1980 on seem to be twice the 1979 rate without difference by commune or zone. In the two belts S1-I-S2 we find an increase in deaths since 1977 in females, constant in time at 40 cases per 100 000 compared to•the expected 24 cases. DISEASES OF THE NERVOUS SYSTEM AND SENSORY ORGANS (370-389, A? 2A79) . The trend is constant through time and, given the small number of deaths, there are no differences even at territorial level. RHEUMATIC FEVER AND CHRONIC RHEUMATIC HEART DISEASE (390-398, A8CA81) - Mothina noteworthy. �HYPERTENSION ( 0 - 0 , AS2) - Here again, the increase noted in 4044 1980-81 is probably due to a coding overestimate. At all events there are no important differences territorially. It should, however, be mentioned that the mortality rate of females is slightly higher in the belts S1+S2 and S3+S4 as from 1977 compared to the zones rated blank. ISCHEMIC HEART DISEASE (410-414, A83) AND OTHER HEART DISEASES (420-429, A84) - As stated earlier, there is a peak in 1976 for females, but it does not seem to be attributable to the accidenx as the distribution of deaths was homogeneous throughout 1976 before and after 10 July, At territoral level there are no significant differences. There is a slight decline through time. CIRCULATORY DISEASES OF THE BRAIN (430-438, A 85) - The time trend is downward with 70 deaths per 100 000 inhabitants in the past few years compared to 100—110 in 1976. DISEASES OF THE ARTERIES, ARTERIOLES AND CAPILLARIES ( 4 - 4 , 4048 A86) - The time trend is constant and there are no noteworthy differences within the territory attributable to the ICMSSA accident. -EMBOLISM AND VENOUS THROMBOSIS (450-453, A87) - Nothing noteworthy. OTHER DISEASES OF THE CIRCULATORY SYSTEM (454-458, A88) - Nothing noteworthy. ACUTE RESPIRATORY TRACT INFECTIONS, INFLUENZA OR GRIPPE AND PNEUMONIA ( 6 - 8 , A89-A92) AND BRONCHITIS, EMPHYSEMA AND ASTHMA 4046 ( 9 - 9 , A93) AND OTHER DISEASES OF THE RESPIRATORY SYSTEM (5004043 519, A94-A96) - The time trend is downward. PEPTIC ULCER (531-533, A98) - Nothing noteworthy. �APPENDICITIS AND INTESTINAL OCCLUSION, HERNIA AND PERITONITIS (54C-543, 550-554, 560-576-568, A100, A101, A104-0) - Nothing noteworthy. CIRRHOSIS OF THE LIVER AND OTHER DISEASES OF THE LIVER AND GALLBLADDER (570-573, 576, A101.1), OTHER DISEASES OF THE DIGESTIVE TRACT (520-530, 534-537, 561-567, 569, 574, 575, 577, A97, A99, A103, A104.2, A104.9) - The time trend is constant. There are no differences of any interest either between communes or between zones A , 3 , R or betwent belts. GENITOURINARY TRACT DISEASES (580-629, A105-A111) - Nothing significant. The number of cases is tiny. CONGENITAL MALFORMATIONS AND SOME CAUSES OF PERINATAL MORBIDITY AND MORTALITY (740-749, A126-135). The time trend is stable. Within the territory there were 5 cases in zone B for 1980-81 • against 1.34 expected, with a relative risk of 3.7 and in belts S1+S2 there were 7 cases among males in 1981 against 2.55 expected, with a relative risk of 2.75. This could, however, be a random phenomenon, as will be explained in detail in the study on malformations now approaching completion. ILL-DEFINED MORBID SYMPTOMS, OTHER DISEASES AND CAUSES NOT FOUND - There is nothing noteworthy apart from, a slightly rising trend of ill-defined symptoms for the years 1980-81, perhaps due to differences of coding. The number of cases is very small. ACCIDENTS, POISONING, INJURIES (300-999, A138-A150) - The time trend is stable.As to territorial distribution, there is nothing noteworthy either between communes or belts. In zone A there were 5 cases in the two years 1976-1977 compared to the 0.5 expected and the 3 deaths in 1976 from injury occurred before 10 July. �DEATHS FROM ALL CAUSES - Tiie apparent excess in zone A in 1976 is distributed equally before and.after the accident. TUMORS - With regard to the trend of individual tumor types, it may be said that the situation reflects that of northern Italy, taking into account the socioeconomic status of the area under study. No dioxin-related differences were found either between communes or between zones or between belts. The time trends are very close to the nationwide trends for tumors of the stomach and a slight increase for intestinal tumors, especially in females . There was a small increase in hepatic tumors. For respiratory tract tumors there was an increase in line with that of industrialised areas, especially in females. Tumors of the breast are likewise on the increase, as throughout northern Italy6 Tumors of the uterus show a decline. There is an appreciable decline in prostatic tumors while the trend of bladder tumors is stationary. • Nothing noteworthy for the moment for lymphomas and leukemias. Discussion From the purely statistical angle the data we have reported yield no information that suggests that the ICMESA accident appreciably altered the specific mortality rates by sex, age and cause in the population resident in the area monitored. This statement refers mainly to the trend within the area under study. 3y that we mean that with the level of sensitivity pertaining to a mortality study based on the compulsory notification of death (ISTAT form D4/D5) no significant clusters were observed within the area either in space or time that could be attributed to the accident. �To understand clearly tlie characteristics and limitations cf •mortality survey's ~enerallv and of this one in particular, one • needs to consider the following points. In the first place, any study hinging on causes of, death is obviously concerned only with, serious diseases with a high lethality rate. To be recorded these diseases must be easily diagnosed and not confused with more frequent causes of death. In the case of deaths from rare or infrequent diseases, if these diseases do not present precisesigns and symptoms they may easily be missed by the physician who completes the ISTAT form. Other problems bearing more particularly on our study concern the controls and the definition of exposed and nonexposed. or at any rate of more or less exposed persons. The IT.VO aspects to some extent merge in that as soon as one decides to make an internal comparison it is obviously important to define the potential exposure of the area. Migration within and outside the area further compound the problem. In our study we have sought to define the areas in different ways with the aim of identifying the best possible definition of the areas at risk. Our impression at the moment is that by taking the resident population year by year we have reached the highest level of sensitivity attainable in a situation like the one with which we are dealing in the Seveso area. As stated in the report on priority activities, the mortality survey cf residents must new be followed by a closer investigation: on the cohort of 1C/7/7S. "ith the data currently available such a study, which could hardly be achieved in 1930, now becomes relatively simple. In short, we think that the next mortality s-v.dy should be handled �- definition of the cohort of residents as at 10 July 1976; - better use of the indicators of exposure for the definition of belts; - conduct of external comparisons using the ISTAT tapes available up to 1978; - review of the coding system with the ISTAT operators. �10 11 12 I 1 = VERY HIGH RISK BELT 2= HIGH RISK BELT 3= MEDIUM-HIGH RISK BELT = MEDIUM-LOW RISK BELT 13 14 15 16 17 18 � Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Alvin L. Young Collection on Agent Orange Description An account of the resource <p style="margin-top: -1em; line-height: 1.2em;">The Alvin L. Young Collection on Agent Orange comprises 120 linear feet and spans the late 1800s to 2005; however, the bulk of the coverage is from the 1960s to the 1980s and there are many undated items. The collection was donated to Special Collections of the National Agricultural Library in 1985 by Dr. Alvin L. Young (1942- ). Dr. Young developed the collection as he conducted extensive research on the military defoliant Agent Orange. The collection is in good condition and includes letters, memoranda, books, reports, press releases, journal and newspaper clippings, field logs and notebooks, newsletters, maps, booklets and pamphlets, photographs, memorabilia, and audiotapes of an interview with Dr. Young.</p> <p>For more about this collection, <a href="/exhibits/speccoll/exhibits/show/alvin-l--young-collection-on-a">view the Agent Orange Exhibit.</a></p> Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Box The box containing the original item. 095 Folder The folder containing the original item. 2417 Series The series number of the original item. Series IV Subseries IV Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Creator An entity primarily responsible for making the resource Apricena, Matteo Luigi Falliva Rosella Ghioldi Riccardo Puntoni Emanuele Stagnaro Marina Vercelli Leonardo Santi Giulio Dorigotti Luigi Meazza Title A name given to the resource Typescript: Survey of Mortality in the Seveso Area: 1975-1981 Subject The topic of the resource mortality trends Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Alvin L. Young Collection on Agent Orange Description An account of the resource <p style="margin-top: -1em; line-height: 1.2em;">The Alvin L. Young Collection on Agent Orange comprises 120 linear feet and spans the late 1800s to 2005; however, the bulk of the coverage is from the 1960s to the 1980s and there are many undated items. The collection was donated to Special Collections of the National Agricultural Library in 1985 by Dr. Alvin L. Young (1942- ). Dr. Young developed the collection as he conducted extensive research on the military defoliant Agent Orange. The collection is in good condition and includes letters, memoranda, books, reports, press releases, journal and newspaper clippings, field logs and notebooks, newsletters, maps, booklets and pamphlets, photographs, memorabilia, and audiotapes of an interview with Dr. Young.</p> <p>For more about this collection, <a href="/exhibits/speccoll/exhibits/show/alvin-l--young-collection-on-a">view the Agent Orange Exhibit.</a></p> Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Box The box containing the original item. 028 Folder The folder containing the original item. 0453 Series The series number of the original item. Series III Subseries I Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Creator An entity primarily responsible for making the resource Apricena, Matteo Luigi Falliva Rosella Ghioldi Riccardo Puntoni Emanuele Stagnaro Marina Vercelli Title A name given to the resource Survey of Mortality in the Seveso Area, 1975-1981 Subject The topic of the resource Italy human exposure ao_seriesIII