Evidence From Humans
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Mortality and morbidity among people living close to incinerators: a cohort study based on dispersion modeling for exposure assessment
Ranzi, A., Fano, V., Erspamer, L., Lauriola, P., Perucci, C. A., Forastiere, F. Environ Health. 2011. 10, 22.
Topic area
Environmental pollutant - Air pollution
Study design
Retrospective cohort
Funding agency
Interreg IIIC European Project "Enhance health: En
Study Participants
Menopausal Status
The menopausal status of women included in this study is listed here.
No analysis based on menopausal status
Number in Cohort
Cohort: 16,193 women
Cohort participation rate
Not applicable. This study was records-based.
Participant selection: Inclusion and exclusion criteria
Criteria used to select participants in the study.
The cohort included 31,347 residents in the municipality of Forli, Italy who lived within a 3.5 km radius around two incinerators between 1990 and 2003. Participants who entered the study area after 1990 were required to have maintained residence for at least 5 years in order to be included. Participants were identified through the General Registry Office of Forli and followed until 2003 through regional mortality database and cancer registry.
Comment about participation selection
The study attempted to incorporate latency of disease by requiring 5 years of residence in the study area for those participants who entered the area after 1990.
Exposure Investigated
Exposures investigated
Residential exposures to heavy metals estimated at geocoded address using emissions data from a separate study conducted 1997-2000 and a dispersion model -- the Atmospheric Dispersion Modeling System (ADMS). The ADMS provided estimates of annual average c
How exposure was measured
Environmental sample GIS/geographic location
Exposure assessment comment
The exposure time period from 1997-2000 may not reflect exposure earlier in the follow up period, which extended from 1990 to 2003. Of note, the municipal solid waste (MSW) incinerator was found to have higher values of dioxin emission from 1994 (the first available year's data) to 1996 compared to recent years, which was not captured in the exposure time used in the study. Also, the MSW incinerator began operating in 1976, while the hospital waste incinerator began operating in 1991, after the study had already started. PCBs, dioxins, and other pollutants were measured but not considered in the model.
Breast cancer outcome investigated
Primary incident breast cancer
Confounders considered
Other breast cancer risk factors, such as family history, age at first birth, and hormone replacement therapy use, that were taken into account in the study.
Age; calendar period; census-block indicator of SES based on information about education, employment, housing conditions and family composition from 2001 Forli census data in 1,116 census areas; and NO2 concentrations, modeled from the ADMS using emission
Genetic characterization included
If the study analyzed relationships between environmental factors and inherited genetic variations, this field will be marked “Yes.” “No”, if not.
Strength of associations reported
Breast cancer incidence in study area compared to regional population: SIR 1.15 (95% CI 1.03-1.27)

Breast cancer incidence within study area and annual mean atmospheric concentration of heavy metals
(Ref = 1st quartile metal exposure):
Quartile 2: aIRR 0.89 (95% CI 0.68-1.17)
Quartile 3: aIRR 0.78 (95% CI 0.59-1.03)
Quartile 4: aIRR 0.76 (95% CI 0.51-1.13)

Breast cancer mortality within study area and annual mean atmospheric concentration of heavy metals
(Ref = 1st quartile metal exposure):
Quartile 2: aIRR 1.33 (95% CI 0.73-2.43)
Quartile 3: aIRR 1.02 (95% CI 0.55-1.92)
Quartile 4: aIRR 2.00 (95% CI 1.00-3.99)
Author address
Environmental Health Reference Centre, Regional Agency for Environmental Prevention of Emilia Romagna, Modena, Italy.
Reviewers Comments
No individual data about potential confounding factors, such as family history, smoking, alcohol, physical activity, etc. were considered. The time period limits the ability to evaluate the effects of duration of exposure and latency since first exposure.
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