Epidemiology, exposure patterns and survival of malignant mesothelioma in Apulia, Italy (1993–2025): a population-based retrospective registry study
- 1Section of Occupational Medicine, Interdisciplinary Department of Medicine, University of Bari, Bari, Italy
- 2Pathology Unit, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari, Bari, Italy
- 3Department of Medical and Surgical Science, University of Foggia, Foggia, Italy
Abstract
Objectives: To characterise the epidemiology, asbestos-exposure patterns, spatial distribution and survival of malignant mesothelioma in Apulia, Italy.
Design: Population-based retrospective registry study.
Setting: Apulian Regional Mesothelioma Registry, a regional operating centre of the Italian National Mesothelioma Registry.
Participants: All 2281 malignant mesothelioma cases recorded between 1993 and 2025.
Interventions: None.
Primary and secondary outcomes: 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.
Results: 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 km 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<0.001). Older age, male sex and pleural site independently predicted higher mortality.
Conclusions: 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.
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BibTeX
@article{maria2026epidemiology,
title = {{Epidemiology, exposure patterns and survival of malignant mesothelioma in Apulia, Italy (1993–2025): a population-based retrospective registry study}},
author = {Luigi De Maria and Domenica Cavone and Giuseppe Delvecchio and Gabriella Serio and Antonio Caputi and Stefano Sole and Giorgia Aloia and Valentina Lupariello and Adriano Pierfelice and Alessandra Sindaco and Valentina Schino and Angela Stufano and Luigi Vimercati},
journal = {BMJ Open},
year = {2026},
month = oct,
doi = {10.1136/bmjopen-2026-120874},
url = {https://bmjopen.bmj.com/lookup/doi/10.1136/bmjopen-2026-120874},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Epidemiology, exposure patterns and survival of malignant mesothelioma in Apulia, Italy (1993–2025): a population-based retrospective registry study
AU - Luigi De Maria
AU - Domenica Cavone
AU - Giuseppe Delvecchio
AU - Gabriella Serio
AU - Antonio Caputi
AU - Stefano Sole
AU - Giorgia Aloia
AU - Valentina Lupariello
AU - Adriano Pierfelice
AU - Alessandra Sindaco
AU - Valentina Schino
AU - Angela Stufano
AU - Luigi Vimercati
PY - 2026
DA - 2026/10/05
JO - BMJ Open
DO - 10.1136/bmjopen-2026-120874
UR - https://bmjopen.bmj.com/lookup/doi/10.1136/bmjopen-2026-120874
AB - Objectives: To characterise the epidemiology, asbestos-exposure patterns, spatial distribution and survival of malignant mesothelioma in Apulia, Italy. Design: Population-based retrospective registry study. Setting: Apulian Regional Mesothelioma Registry, a regional operating centre of the Italian National Mesothelioma Registry. Participants: All 2281 malignant mesothelioma cases recorded between 1993 and 2025. Interventions: None. Primary and secondary outcomes: 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. Results: 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 km 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<0.001). Older age, male sex and pleural site independently predicted higher mortality. Conclusions: 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.
SN - 2044-6055
SN - 2044-6055
ER -