{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T22:41:58Z","timestamp":1787611318105,"version":"build-2736575974"},"reference-count":46,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2024,6,29]],"date-time":"2024-06-29T00:00:00Z","timestamp":1719619200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["American J Industrial Med"],"published-print":{"date-parts":[[2024,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objectives<\/jats:title><jats:p>In Italy, asbestos was used intensively until its ban in 1992, which was extended for asbestos cement factories until 1994. The aim of this study was to evaluate the dose\u2013response between asbestos exposure and asbestosis mortality across a pool of Italian occupational cohorts, taking into account the presence of competing risks.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Cohorts were followed for vital status and the cause of death was ascertained by a linkage with mortality registers. Cause\u2010specific (CS) Cox\u2010regression models were used to evaluate the dose\u2010exposure relationship between asbestosis mortality and the time\u2010dependent cumulative exposure index (CEI) to asbestos. Fine and Gray regression models were computed to assess the effect of competing risks of death.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The cohort included 12,963 asbestos cement workers. During the follow\u2010up period (1960\u22122012), of a total of 6961 deaths, we observed 416 deaths attributed to asbestosis, 879 to lung cancer, 400 to primary pleural cancer, 135 to peritoneal cancer, and 1825 to diseases of the circulatory system. The CS model showed a strong association between CEI and asbestosis mortality. Dose\u2013response models estimated an increasing trend in mortality even below a CEI of 25 ff\/mL\u2010years. Lung cancer and circulatory diseases were the main competing causes of death.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Asbestos exposure among Italian asbestos\u2010cement workers has led to a very high number of deaths from asbestosis and asbestos\u2010related diseases. The increasing risk trend associated with excess deaths, even at low exposure levels, suggests that the proposed limit values would not have been adequate to prevent disability and mortality from asbestosis.<\/jats:p><\/jats:sec>","DOI":"10.1002\/ajim.23629","type":"journal-article","created":{"date-parts":[[2024,6,29]],"date-time":"2024-06-29T09:59:41Z","timestamp":1719655181000},"page":"813-822","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Asbestos exposure and asbestosis mortality in Italian cement\u2010asbestos cohorts: Dose\u2010response relationship and the role of competing death causes"],"prefix":"10.1002","volume":"67","author":[{"given":"Paolo","family":"Girardi","sequence":"first","affiliation":[{"name":"Department of Environmental Sciences, Informatics and Statistics Ca' Foscari University of Venice Venezia 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