[Mortality in the area around Massa-Carrara 10 years after ANIC-Agricoltura and Farmoplant chemical plants were shut down].

Objective: To describe mortality of residents in the area of Massa-Carrara for the period 1995-2000 and to compare it with mortality for the years 1990-1994.

Design: Geographical descriptive study.

Setting: In the area of Massa-Carrara cause and gender specific standardized mortality ratios (SMR), adjusted for age and municipal deprivation index (reference: Tuscany Region), have been computed for the years 1995-2000 and compared with mortality in the period 1990-1994 calculating ratios between standardized rates by age classes with a direct method (CMF). For those causes showing a statistically significant increase a spatial analysis on a group of municipalities around Massa and Carrara has been carried out.

Main Outcome: Mortality for all causes, and for 30 specific causes.

Results: The study results confirm, for the years 1995-2000, the previous observation (1990-1994) of statistically significant excesses for mortality from all causes (SMR 109), all cancers (SMR 112), respiratory diseases (SMR 126), cirrhosis (SMR 226), liver (SMR 161) and lung cancer (SMR 115) in males. A statistically significant excess for larynx (SMR 158) and pleural cancer (SMR 178) is observed in the years 1995-2000, which was not present in 1990-1994. A mortality excess for cirrhosis is confirmed in females (SMR 158) and a new one emerges for liver cancer (SMR 144). The comparison between mortality data for the periods 1995-2000 and 1990-1994 has shown a statistically significant decrease in mortality for all causes and for several specific causes, a significant increase in liver (CMF males 1.35; CMF females 1.78) and blood cancer mortality is also detected (CMF females 1.44).

Conclusions: This study confirms the negative health impact of environmental, occupational exposures in populations living in areas where high-risk factories are located. Adverse health effects are stronger in socially and economically deprived areas, and persist over many years after closing polluting industrial plants. The results of this study point out to the need of health promoting actions aiming at modifying lifestyle risk factors, ameliorating socio-economic conditions, and maintaining a constant control on environment, also through a specific environmental epidemiological surveillance to monitor the impact of reclamation procedures completed or in progress.