Health status of male steel workers at an electric arc furnace (EAF) in Trentino, Italy

Abstract

BackgroundThe aim of this retrospective cohort study was to determine if the workers of an Electric Arc Furnace (EAF), which recycles scrap, had higher mortality and morbidity due to possible exposure to pollutants at work. EAFs do not run on coke ovens. In EAFs 40 % of the particulate matter (PM) is made up of PM 2.5. The foundry dust contained iron, aluminum, zinc, manganese, lead, chromium, nickel, cadmium, mercury, arsenic, polycyclic aromatic hydrocarbons (PAHs), polychlorinated biphenyls and dioxins.MethodsMortality study: a cohort of 331 exposed workers (6731 person-years) was studied from 19/03/1979 to 31/12/2009 (mean follow up 20.7 years). The group of exposed workers was compared to the general population and to a small control group of 32 workers from the same company.Morbidity study: rates of exemption from health fee for the seven major diseases of 235 exposed workers were compared to the rates of exemption in the Province of Trento.ResultsMortality study: an excess mortality was found in the exposed workers as compared to the general population (SMR 1.13; 95 % CI: 0.76–1.62; 29 deaths) and to the internal group (RR 2.34; 95 % CI: 0.39–95.7). The mortality rate was increased for all tumours (SMR 1.36; 95 % CI: 0.75–2.29; 14 cases), for lung cancer (SMR 3.35; 95 % CI 1.45–6.60; 8 cases), for ischemic heart disease (SMR 1.27; 95 % CI: 0.35–3.26; 4 cases), for chronic liver disease (SMR 1.16; 95 % CI: 0.14–4.20; 2 cases) and for injury and poisoning (SMR 1.32; 95 % CI: 0.48–2.88; 6 cases).Morbidity study: there was a statistically significant increase of diabetes, rheumatoid arthritis, hypertension and cardiovascular diseases in exposed workers.ConclusionsWith the limitations of this relatively small cohort, we found a statistically significant increase of diabetes, cardiovascular diseases and deaths due to lung cancer in exposed workers. These findings cannot be explained by PAH exposure alone; metal particulates are the most important pollutants in the working area of EAFs. A reliable method for measuring metal PM in tissues is urgently needed for exposure assessment. This study underlines the necessity to maximize the standards of security toward foundry dusts/diffuse emission. Further studies on EAF’s are needed to confirm our findings and to increase statistical power.

Could the significantly increased risk of rheumatoid arthritis reported in Italian male steel workers be explained by occupational exposure to cadmium?

“…Clear associations between chronic disease and occupations with cadmium inhalation as described by Cappelletti et al [ 1 ] and others [ 3 – 5 ] have been demonstrated. Further epidemiological work related to occupational cadmium exposure and disease development, particularly with regard to RA, is required to modify behaviour influencing development of future chronic disease.…”

“…We read with interest by Cappelletti et al “Health status of male steel workers at an electric arc furnace in Trentino, Italy [ 1 ]”. The authors demonstrated significantly increased disease risk; specifically, rheumatoid arthritis (RA), hypertension and cardiovascular diseases in exposed workers.…”

Is Male Rheumatoid Arthritis an Occupational Disease? A Review

“…[ 15 ] suggest an OR of 2.6 (OR 1.0-7.4) for ACPA+ RA in smelters and metal foundry workers. A retrospective cohort study of workers recycling scrap metals at an electrical arc furnace in Italy noted 3/331 incident cases of RA over a 20 year follow up period, a dramatically increased RR of 6.18 (95%CI 2.00-19.02), when compared to 420/20332 incident RA cases in the same town over the same period [ 33 ]. Despite the relatively small sample size and lack of directly comparable working group, this cohort demonstrated an appreciably elevated RA risk, thought due to foundry dust exposure containing a range of potential toxins including heavy metals [ 34 ].…”

Is Insulin Resistance Work Related?

“…Heavy metals: Numerous studies indicated an association between heavy metals and insulin resistance (cardio-vascular diseases and diabetes) [122][123][124][125][126][127] explained by their direct effects on ROS production and inflammatory mediated cellular and systemic damage, decreased mitochondrial function with reduction of the capacity for fatty acid oxidation, inhibition of lipoprotein lipase in adipocytes and β-cells destruction [128]. Maternal gestational diabetes is also increased by heavy metal exposure [129].…”