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Cancer mortality and congenital anomalies in a region of Italy with intense environmental pressure due to waste
  1. M Martuzzi1,
  2. F Mitis1,
  3. F Bianchi2,
  4. F Minichilli2,
  5. P Comba3,
  6. L Fazzo3
  1. 1
    World Health Organization Regional Office for Europe, Rome, Italy
  2. 2
    Unit of Epidemiology, CNR Institute of Clinical Physiology, Pisa, Italy
  3. 3
    Department of Environment and Primary Prevention, Istituto Superiore di Sanità, Rome, Italy
  1. Correspondence to Marco Martuzzi, World Health Organization Regional Office for Europe, Via Francesco Crispi, 10 – I-00187, Rome, Italy; mam{at}


Objectives: Waste management in the Campania region has been characterised, since the 1980s, by widespread uncontrolled and illegal practices of waste dumping, generating concerns over the health implications. The objective of this study was to evaluate possible adverse health effects of such environmental pressure.

Methods: The health effects of waste-related environmental exposures in Campania were assessed in a correlation study on nine causes of death (for the years 1994–2001) and 12 types of congenital anomaly (CA) (1996–2002) in 196 municipalities of the provinces of Naples and Caserta. Poisson regression was used to analyse the association between health outcomes and environmental contamination due to waste, as measured through a composite index, adjusting for deprivation.

Results: Statistically significant excess relative risks (ERR, %) in high-index compared with low-index (unexposed) municipalities were found for all-cause mortality (9.2 (95% CI 6.5 to 11.9) in men and 12.4 (9.5 to 15.4) in women and liver cancer (19.3 (1.4 to 40.3) in men and 29.1 (7.6 to 54.8) in women). Increased risks were also found for all cancer mortality (both sexes), stomach and lung cancer (in men). Statistically significant ERRs were found for CAs of the internal urogenital system (82.7 (25.6 to 155.7)) and of the central nervous system (83.5 (24.7 to 169.9)).

Conclusion: Although the causal nature of the association is uncertain, findings support the hypothesis that waste-related environmental exposures in Campania produce increased risks of mortality and, to a lesser extent, CAs.

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  • Funding The study was partially funded by the Italian Government, Department of Civil Defence. This contribution was used for manpower, travel and meeting expenses. The sponsor of the study had no role in study design, data analysis, data interpretation, or writing of the report; it contributed to building the waste index, through participating in a dedicated working group.

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.