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Annibale Biggeri,¹ Fabio Barbone,^2,3 Corrado Lagazio,¹ Massimo Bovenzi,⁴ and Giorgio Stanta⁵

¹Department of Statistics "G. Parenti," University of Florence, Florence, Italy; ²Unit of Hygiene and Epidemiology, DPMSC, University of Udine, Udine, Italy; ³Epidemiology Unit, Aviano Cancer Center, Aviano, Italy; ⁴Institute of Occupational Medicine, University of Trieste, Trieste, Italy; ⁵Institute of Pathology, Cancer Registry of the Province of Trieste, Trieste, Italy

Abstract

To investigate the relationship between four sources of environmental pollution (shipyard, iron foundry, incinerator, and city center) and lung cancer risk, we conducted a case-control study of deceased men in Trieste, Italy. We identified 755 cases of lung cancer and 755 controls through the local autopsy registry. Information on smoking habits, occupational history, and place of residence were obtained from the subject's next of kin. The case-control design was used to properly account for subject-specific confounders, which represent a major problem in geographical analysis. Spatial models were used to evaluate the effect of sources of pollution on lung cancer after adjustment for age, smoking habits, likelihood of exposure to occupational carcinogens, and levels of air particulate. The models are based on distance from the sources and enable estimation of the risk gradient and directional effects separately for each source. The risk of lung cancer was highly related to the city center (p = 0.0243) , with an excess relative risk at zero distance of 2.2 and a smooth decrease moving away from the source (-0.015) , and related to the incinerator (p = 0.0098) , with an excess relative risk of 6.7 in the source and a very steep decrease (-0.176) . These results are consistent with findings of previous analyses and provide further evidence that air pollution is a moderate risk factor of lung cancer. Key words: air pollution, epidemiology, geographical analysis, lung cancer. Environ Health Perspect 104:750-754 (1996)

Address correspondence to C. Lagazio, Department of Statistics "G. Parenti," University of Florence, Viale Morgagni 59, 50134 Firenze, Italy.

This work was partially supported by the Consiglio Nazionale delle Ricerche (CNR) , grant no. 8400604.44 and by the Ministero dell'Università e della Ricerca Scientifica e Tecnologica (MURST) , 60% grants. We thank the referees for suggestions that led to substantial improvements in the content and organization of the paper.

Received 13 November 1995 ; accepted 27 March 1996.