{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T14:07:22Z","timestamp":1791209242112,"version":"4.1.0"},"reference-count":44,"publisher":"BMJ","issue":"10","license":[{"start":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T00:00:00Z","timestamp":1791158400000},"content-version":"unspecified","delay-in-days":4,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,9,21]]},"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To characterise the epidemiology, asbestos-exposure patterns, spatial distribution and survival of malignant mesothelioma in Apulia, Italy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Population-based retrospective registry study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Apulian Regional Mesothelioma Registry, a regional operating centre of the Italian National Mesothelioma Registry.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>All 2281 malignant mesothelioma cases recorded between 1993 and 2025.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Interventions<\/jats:title>\n                    <jats:p>None.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Primary and secondary outcomes<\/jats:title>\n                    <jats:p>Primary outcomes were case distribution, population-adjusted incidence, asbestos-exposure category and overall survival. Secondary outcomes included temporal trends, municipal patterns, proximity of environmentally exposed cases to the former Fibronit plant in Bari and factors independently associated with mortality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Overall, 1689 cases (74.0%) occurred in men; mean age at diagnosis was 67.8 years and 2018 cases (88.5%) were pleural. Occupational exposure accounted for 49.8% of cases, environmental exposure for 8.9% and familial exposure for 2.4%. Taranto had the highest municipal annual incidence (7.43 per 100 000), followed by Bari (4.59). Among 112 environmentally exposed Bari cases with reconstructed residential distance, 89.3% lived within 1\u2009km of the former Fibronit plant. Kaplan-Meier median survival was 1.0-year and 5-year survival was 10.1%. Survival improved across diagnostic periods (p&lt;0.001). Older age, male sex and pleural site independently predicted higher mortality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Mesothelioma in Apulia reflects persistent occupational and environmental consequences of historical asbestos use. Geographical hotspots and poor survival support continued registry surveillance, remediation of contaminated sites and targeted health monitoring of formerly exposed workers and communities.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2026-120874","type":"journal-article","created":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T13:35:20Z","timestamp":1791207320000},"page":"e120874","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Epidemiology, exposure patterns and survival of malignant mesothelioma in Apulia, Italy (1993\u20132025): a population-based retrospective registry study"],"prefix":"10.1136","volume":"16","author":[{"given":"Luigi","family":"De Maria","sequence":"first","affiliation":[{"name":"Section of Occupational Medicine, Interdisciplinary Department of Medicine, University of Bari, Bari, 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