OBJECTIVE:Hospices represent the cornerstone of modern palliative services. However, population-level data on hospice utilization and characteristics of patients dying in hospice remain limited to examine national temporal trends in hospice deaths in Italy from 2011 to 2022, with a focus on the underlying causes of death. METHODS:We performed a nationwide, population-based retrospective study using official mortality data from the Italian National Institute of Statistics. All deaths registered in Italy between 2011 and 2022 were included. Hospice deaths were identified as those occurring in licensed hospice facilities. RESULTS:Hospice beds increased from 1,681 in 2011 to 3,419 in 2022, while hospice deaths more than doubled from 19,179 (3.2% of all deaths) to 43,972 (6.2%). The mean age of hospice deaths rose from 74.0 to 76.6 years. Among patients dying in hospice, neoplasms remained the leading cause of death but declined from 87.0% in 2011 to 73.8% in 2022, while cardiovascular deaths increased from 6.2% to 9.5%, neurological from 1.2% to 3.4%, and respiratory from 1.0% to 2.5%. The proportion of national neoplasm deaths occurring in hospice reached approximately 20% in 2022. Similarly, the proportion of non-neoplasm hospice deaths tripled (0.6-2.1%). SIGNIFICANCE OF THE RESULTS:Between 2011 and 2022, hospice deaths in Italy more than doubled, reflecting substantial progress in expanding access to palliative care. The gradual increase in non-neoplasm hospice deaths suggests a shift toward greater inclusivity, although neoplasm remains predominant.

This study investigates how different spatiotemporal temperature models affect the estimation of heat-related mortality in Lazio, Italy (2008–2022). First, we compare three methods to reconstruct daily maximum temperature at the municipality level: two Bayesian regression models, one quantile and one Gaussian, and the gridded reanalysis data from ERA5-Land. Both Bayesian models are station-based and exhibit higher and more spatially variable temperatures compared to ERA5-Land. Then, using individual mortality data for cardiovascular and respiratory causes, we estimate temperature and heatwaves mortality associations through Bayesian conditional Poisson models in a case-crossover design. All models exhibit a marked increase in relative risk at high temperatures; however, the temperature of minimum risk varies significantly across methods. Stratified analyses reveal higher relative risk increases in females and the elderly (80+). Results confirm the importance of temperature model choice in epidemiology and provide insights for early warning systems and climate-health adaptation strategies.

BACKGROUND:Italy, among the leading asbestos producers and users until the national ban in 1992, continues to register a high burden of asbestos-related diseases, mainly due to their long latency and delays in remediation. This study investigates the spatio-temporal evolution of pleural mesothelioma (PM) mortality over the past 40 years. MATERIALS AND METHODS:Malignant pleural tumours and PM deaths (1980-2020) were extracted from the national death registry, adjusted for misclassification of pleural tumours, and analysed by region and birth cohort (1905-1984). The analyses by calendar period and cohort, stratified by sex assigned at birth, were followed by a space-cohort Bayesian Hierarchical Model with structured random effects for time (cohorts up to 1960-1969) and space (administrative regions). RESULTS:In Italy, from 1980 to 2020, 35 134 people died from PM (24 380 males and 10 754 females). A mortality decrease was observed in males after 2010-14 and in females after 2000-4. Mortality steadily declined in both males and females across cohorts after 1935-44. The space-time analysis enabled the clear identification of the Italian regions most affected by PM. CONCLUSION:Italy's trend mirrors those of other Western countries that have banned asbestos, with the highest risks for birth cohorts in working age before the ban. The results reveal distinct spatio-temporal patterns, with the northern regions exhibiting the highest rates. The Italian experience with asbestos-related diseases detection could help other countries to assess the impact of asbestos, raise awareness, and promote a global ban on asbestos.

High temperatures are increasingly associated with adverse mental health outcomes, yet the influence of structural modeling assumptions on these estimates remains underexplored. This study examined the short-term association between high temperatures and mental health-related-hospitalizations in 21 major Italian cities from 2005 to 2023, using national hospital discharge data. Exposure-lag-response relationships were modeled through a Distributed Lag Nonlinear Model (DLNM) framework estimated within a Generalized Additive Model (GAM). Analyses focused on June-September and included hospitalizations with a primary diagnosis of mental disorders, considering the code 295-316 of the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM). A Global Sensitivity Analysis (GSA) assessed how structural decisions, such as the specification of temperature and lag splines, and the inclusion of September, affect risk estimates. A total of 210,310 hospitalizations were recorded. The cumulative exposure-response curve showed a marked nonlinear increase in risk, reaching relative risk values close to two at temperatures exceeding 40 ∘ C $^\circ\rm{C}$ . The GSA revealed that the number and placement of knots in the temperature dimension were the dominant contributors to output variability, with total-order sensitivity indices approaching one across most of the temperature range. Variations in the lag structure contributed minimally, while including or excluding September influenced model fit but only modestly affected risk estimates. Uncertainty quantified through GSA was substantially larger than that quantified by standard confidence intervals, indicating that structural assumptions meaningfully shape inference. Within the DLNM-GAM framework, high summer temperatures were consistently associated with increased psychiatric hospitalizations. Incorporating GSA clarified which modeling choices influence estimates, improving transparency and robustness in evaluating heat-related mental health impacts.

Introduction:Italy, a major former producer, banned asbestos in 1992. A high incidence of mesothelioma, one of the asbestos legacies, is still observed due to the long latency and exposure from residual asbestos-containing materials. Future mortality forecasts at both national and subnational levels are still lacking. This work aims to project future age-stratified mortality rates (2020-2034) for pleural mesothelioma (PM) in Italy, both nationally and for each administrative region. Methods:Data on pleural cancers and PM in Italy between 1980 and 2019 were extracted from death registries, adjusted for PM misclassification in ICD-9, and aggregated in eight periods, eighteen age classes, and fifteen birth cohorts. Bayesian age-period-cohort models were implemented to generate age-specific mortality projections, stratified by sex assigned at birth. Results:Between 1980 and 2019, 33,889 people died from PM in Italy, and 19,092 more deaths are expected between 2020 and 2034. The national peak is predicted for 2020-2024, with 6,740 deaths. Age groups under 75 years have already reached the peak of mortality rates. Region-specific trends by sex and time reflect the country's industrialization history. Discussion:These results align with the literature in predicting the timing of the mesothelioma peak and offer new insights into age-specific trends, the rate of decline, and geographical patterns. They provide valuable evidence on the heterogeneous asbestos legacy across regions, supporting targeted public health actions and health planning.

Introduzione: Le stime degli anni di vita aggiustati per disabilità (Disability Adjusted Life Years: DALYs) rappresentano uno strumento fondamentale per quantificare il carico globale delle malattie e dei fattori di rischio, utili alla pianificazione delle politiche sanitarie [1]. L’amianto è riconosciuto come cancerogeno certo, responsabile di mesotelioma (M), tumori del polmone, dell’ovaio e della laringe, oltre che di asbestosi e ispessimenti pleurici. Nel 2019, a livello globale, si sono stimati 4.189.000 DALYs attribuibili a patologie derivanti dall’esposizione occupazionale all’amianto. In Italia, tra il 2010 e il 2020 si sono registrati 16.993 decessi per M, mentre dal 1993 al 2021 il Registro Nazionale dei Mesoteliomi (ReNaM) ha censito oltre 35.000 casi incidenti. Obiettivo: Stimare i DALYs attribuibili ad asbestosi e mesotelioma, patologie con elevata frazione eziologica legata all’amianto (rispettivamente 80% e 100%), in Italia nel decennio 2010-2020. Metodi: Sono stati presi in considerazione i decessi per M e asbestosi, i ricoveri ospedalieri per asbestosi e i casi incidenti di M. I DALYs sono stati calcolati come somma degli anni di vita persi per morte prematura (PYLLs) e degli anni vissuti con disabilità (YLDs). I decessi per M (ICD-10: C45) e asbestosi (ICD-10: J61), così come i ricoveri per asbestosi (ICD-9: CM 501), sono stati estratti dalle banche dati elaborate dall’ISS, utilizzando fonti ISTAT e Ministero della Salute. I casi incidenti di M sono stati stimati a partire dai dati ReNaM. Le informazioni sono state stratificate per genere, classe di età e anno di calendario. I PYLLs sono stati calcolati in valore assoluto e come tassi standardizzati (per 100.000 abitanti), a livello nazionale e regionale, applicando i valori di speranza di vita ISTAT, disaggregati per genere, età e anno. Gli YLDs sono stati stimati a livello nazionale considerando i ricoveri per asbestosi e i casi incidenti di M, utilizzando un peso di disabilità pari a 0,217 e una durata di 20-30 anni per l ’asbestosi, e un peso di 0,540 con un anno di durata per il M [2, 3]. Risultati: Nel periodo 2010-2020, in Italia si stimano 204.232 DALYs per patologie amianto-correlate tra gli uomini e 72.625 tra le donne, assumendo una durata di 30 anni per l’asbestosi. I PYLLs ammontano a 161.300 nei maschi (di cui il 96,7% per M) e 67.311 nelle femmine (99,1% per M). Le regioni settentrionali, in particolare Liguria, Piemonte e Friuli-Venezia Giulia, mostrano i tassi più elevati di PYLLs per M in entrambi i sessi. Gli YLDs sono pari a 7.075 per M e 35.857 per asbestosi negli uomini, e a 2.710 per M e 2.604 per asbestosi nelle donne. Conclusioni: Per la prima volta in Italia viene proposta una stima del carico complessivo di mesotelioma e asbestosi in termini di DALYs. Questi dati, che includono gli anni vissuti con ridotta funzionalità, rappresentano un supporto rilevante per la programmazione sanitaria e l’attuazione di adeguate misure di welfare.

Chronic pain (CP) is a global healthcare concern requiring careful monitoring. In Italy, the most recent CP prevalence estimates date back to 2003. In this work, we analyzed data from the 2019 European Health Interview Survey, based on a representative sample of the Italian population (n = 44,492), to update national CP prevalence estimates and evaluate its psychosocial burden. CP was detected using a validated questionnaire. Our results show that approximately 10.5 million adults (24.1%) suffer from CP; prevalence and intensity are higher among females and increase with age. In 54.3% of cases, CP was triggered by a diagnosed disease, while 13.6% remain undiagnosed and 14.8% do not seek treatment for CP. Severe CP accounts for 29.4% of cases. Individuals with severe CP are significantly more likely to experience difficulties in social participation (OR 4.82; CI 4.41–5.27), increased work absences (OR 4.18; CI 3.53–4.94), depression (OR 7.10; CI 6.22–8.11), and greater use of primary (OR 2.90; CI 2.64–3.18) and specialist healthcare (OR 2.63; CI 2.40–2.89) as well as diagnostic procedures (OR 2.27; CI 2.07–2.49). Among subjects diagnosed with depression or severe chronic anxiety, CP seems to reduce access to mental health care (OR 0.75; CI 0.61–0.92) and increase abandonment due to financial barriers (OR 1.57; CI 1.07–2.31). Unlike a few countries (e.g., Spain and Denmark) that have recorded a generally increasing trend in CP prevalence, our figures confirm a quite stable national epidemiological pattern. Our estimates underscore the need for careful management of CP and its psychosocial burden. Since data were collected just before the COVID-19 pandemic, they may represent a crucial baseline for monitoring post-pandemic trends.

BACKGROUND:Contaminated sites are among the main worldwide environmental health priorities. The health impact on population living in Italian contaminated sites of national concern for remediation (CSs) with petrochemical/refineries (P&R) and steel plants (S) was estimated. Since these CSs include the major Italian facilities located widespread on the territory are representative of the national reality. Furthermore, the population exposed in P&R and S is significant since it represents about 3% of the national population. METHODS:Two groups of CSs were defined: twelve CSs with P&R and eight with S. Cause-specific mortality (2013-2017) and hospitalization (2014-2018) in both groups were analysed. Pooled Standardized Mortality/Hospitalization Ratios (SMRpooled/SHRpooled) were estimated through random-effect meta-regression of individual site SMR/SHR (reference: CS regional rate). The main groups of diseases and those for which the evidence of an association with the residential exposure to P&R and S was defined limited were analysed in adult while only the main groups of diseases were analysed in paediatric-adolescent and juvenile ages subgroups (0-1, 0-19, 20-29 years). All the analyses were performed separately for the two groups of CSs, and by sex. RESULTS:In the two CSs groups, the overall and the main causes mortality and hospitalization, including all cancers, exceeded in both sexes. Specifically, for lung cancer in the P&R group, among males SMRpooled=1.11 (CI90% 1.00-1.23) and SHRpooled=1.18 (0.99-1.40) and among females SMRpooled=1.13 (1.03-1.25) and SHRpooled=1.20 (1.05-1.38), while in the S group, SMRpooled=1.17 (1.02-1.34) and SHRpooled=1.27 (0.87-1.86) among males and SMRpooled=1.21 (0.93-1.59) and SHRpooled=1.19 (0.91-1.57) among females. The mortality and hospitalization exceeded also for breast cancer in the P&R group. Hospitalization for leukaemia and respiratory diseases increased in the S group. In both CSs groups, among 20-29 years old sub-population, mortality for all tumours and hospitalization for respiratory diseases was worthy of note and hospitalization for all tumours exceeded among 0-1-year age-subgroup. CONCLUSIONS:The results suggest that living in petrochemical/refineries and steel plants CSs is associated with increased risk for specific diseases. The meta-analytical estimates could contribute to assess the order of magnitude of health impacts of contaminated sites and to perform integrated evaluation of health and environmental impact.

The COVID-19 pandemic has severely impacted Italy, leading to millions of cases and high mortality rates. Pre-existing chronic respiratory diseases may influence patient outcomes, and understanding their role is essential for improving healthcare strategies during such crises. This study analysed data from the Italian hospital discharge records database to explore the association between chronic respiratory diseases and in-hospital mortality due to COVID-19. Patients hospitalized in 2020 were studied, with exposure to respiratory diseases assessed based on hospitalizations between 2010 and 2019. Cox regression models were used to adjust for demographic and clinical factors, including age, gender, and comorbidity. Patients with pre-existing chronic respiratory diseases (n = 28 375, 13.9% of the total study population of 203 820) had a 71% higher risk (hazard ratio: 1.71, confidence interval: 1.54-1.90, P < .001) of in-hospital mortality compared to those without such conditions. Age, gender, the number of previous hospitalizations, and the Charlson comorbidity index were identified as key factors in mortality. Kaplan-Meier survival curves demonstrated significant differences in survival probabilities between exposed and unexposed groups across various age categories. Chronic respiratory diseases are associated with increased COVID-19 mortality, underscoring the need for targeted interventions in vulnerable populations to reduce the impact of future pandemics.

AIMS:Non-communicable diseases (NCDs), including cancer, cardiovascular diseases, diabetes, and chronic respiratory diseases, are responsible for 74% of deaths worldwide (2019). In Europe, they account for over 91% of deaths and 87% of disability-adjusted life years (DALYs). Mental disorders, also considered NCDs, rank seventh globally in terms of DALYs. These burdens are exacerbated by socioeconomic and educational inequalities that shape the distribution of risk factors and cause preventable disparities in health and mortality. This article presents the new Joint Action on Cancer and other NCDs (JA-PreventNCD), outlining its objectives and methodological strategies to tackle inequalities in Europe. METHODS:The JA-PreventNCD started in January 2024. It was launched under the EU4Health Programme for the period of 2021-2027, with a specific focus on social inequalities. Over its four-year span, the initiative will: (1) collect evidence on inequalities in major NCDs and their risk factors; (2) review policies targeting these disparities; (3) provide training based on an equity lens approach; (4) enhance health literacy through multi-level activities. CONCLUSIONS:The JA-PreventNCD initiative represents a crucial opportunity to address health inequalities related to NCDs across Europe. Its findings will contribute to evidence-based health policies and promote sustainable strategies aimed at closing the gaps. Enhanced collaboration among European countries and the exchange of best practices will foster informed policy-making, leading to long-term improvements in public health.

IntroductionSARS-CoV-2 infection has been associated with the onset or persistence of symptoms in the long-term after the acute infection is resolved. This condition known as Post-COVID, might be particularly severe and potentially life-threatening. However, little is known on the impact of post-COVID condition on mortality. Aim of the present study is to assess and quantify Post-COVID deaths in Italy in years 2020 and 2021, based on an analysis of death certificates.MethodsData from the Italian National Cause of Death Register were analyzed. ICD-10 code U09.9, released by the World Health Organization in September 2020, was used to identify the ‘Post-COVID’ condition. Numbers of post-COVID deaths from October 2020 to December 2021 were analyzed. Rates of post-COVID deaths were calculated for the year 2021.ResultsBetween October 2020 and December 2021, 4,752 death certificates reporting post-COVID condition were identified. Of these, 14.9% (n = 706) occurred between October and December 2020 and 85.1% (n = 4,046) in 2021. In 46.0% of post-COVID-related deaths, the underlying cause of death was COVID-19. Other frequent underlying causes were heart disease (14.3% of cases), neoplasms (9.2%), cerebrovascular diseases (6.3%) and Alzheimer’s disease and other dementias (5.5%). The mortality rate related to post-COVID conditions in year 2021 was 5.1 deaths per 100 thousand inhabitants and it increased with increasing age. Men showed a higher mortality rate than women (4.3 deaths per 100 thousand in women and 6.0 deaths per 100 thousand in men).DiscussionPost-COVID conditions contributed to a substantial number of deaths in Italy. Strategies to identify the population at risk of severe long-term consequences of SARS-CoV-2 infection and interventions aimed at reducing this risk must be developed.

BackgroundObesity is associated with numerous severe diseases necessitating intensive healthcare for diagnosis and treatment. Most patients with obesity, especially in its severe form, require at least one hospitalization. However, few studies in Italy have assessed the burden of obesity on the National Health System. This study aims to routinely estimate the ‘disease burden’ by analyzing hospital admissions related to severe obesity.SubjectsWe analyzed the medical records of the Italian national hospital discharge database, including all patients older than 18 years discharged with the diagnosis of ‘severe obesity’.’ We included patients who underwent bariatric surgery, even without an explicit obesity code, such as laparoscopic restrictive gastric procedures, other stomach operations, and high gastric bypass. Special focus was given to those who underwent abdominal reshaping surgery. The cross-sectional survey PASSI in Italy served as an additional data source to estimate. The phenomenon was described using appropriate indicators, including rates and ratios between rates. Linear regression was employed to analyze trends in standardized rates over time.ResultsBetween 2014 and 2021, a total of 243,325 patients were discharged with a severe obesity code in Italy. Among these patients, 36.8% underwent at least one bariatric surgery procedure. We investigated the types of bariatric surgery procedures performed. The most frequent procedure was “other operations on the stomach,” where sleeve gastrectomy is included which also appears to be steadily increasing during the study period together with the gastric bypass, while the gastric bondage is decreasing over time.ConclusionThese findings underscore the significant burden of severe obesity on Italy’s healthcare system, a burden that is progressively increasing. The growing utilization of bariatric surgery suggests an escalating trend toward adopting drastic solutions to combat this health issue.

In this study, we employ a comprehensive approach to model the concurrent effects of the COVID-19 epidemic and heatwaves on all-cause excess mortality. Our investigation uncovers distinct peaks in excess mortality, notably among individuals aged 80 years and older, revealing a strong positive correlation with excess temperatures (ET) during the summer of 2022 in Italy. Furthermore, we identify a notable role played by COVID-19 hospitalizations, exhibiting regional disparities, particularly during the winter months. Leveraging functional data regression, we offer robust and coherent insights into the excess mortality trends observed in Italy throughout 2022.

Background/Objectives: Endometriosis is a female chronic inflammatory disease in which endometrial tissue develops outside the uterine cavity. It is a complex pathology, which significantly contributes to morbidity in premenopausal women, leading to chronic pain, infertility, and subfertility negatively impacting physical and emotional well-being and the overall quality of life. The public health burden of endometriosis remains elusive and challenging to determine, and this uncertainty can lead to inadequate healthcare services and treatments. The objective was to estimate the incidence and prevalence of endometriosis in Italy using the hospital discharge records database via a population-based retrospective study, nationwide between 2011 and 2020. Methods: From the National Hospital Discharge Database, we selected all admissions with a diagnosis of endometriosis (ICD-9-CM, codes 617.x), supported by the presence of a procedure code of laparoscopy or any other surgical procedure allowing for direct visualisation of the lesions. The main outcomes measured: incidence and prevalence of endometriosis were estimated for the entire 2011–2020 period and by individual year, analysing the time trend and variability in different geographical areas of Italy. Results: There were a total of 134,667,646 women aged 15–50 years with one or more hospitalisations for endometriosis in all Italian hospitals. The incidence of endometriosis in Italy during this period was 0.839 per 1000 women (CI95% 0.834–0.844), exhibiting a statistically significant decreasing trend over the years. A discernible north–south gradient was observed, with higher rates documented in the northern regions. The prevalence rate stood at 14.0 per 1000 during the same period, and a similar north–south geographical gradient was identifiable in the prevalence rates as well. Conclusions: The utilization of national-level hospital data enables the generation of incidence and prevalence data for endometriosis without variations in methods and definitions, facilitating the evaluation of temporal trends and regional comparisons. Understanding and quantifying this phenomenon is essential for appropriate healthcare planning in various Italian regions.

Abstract Background Per- and polyfluoroalkyl substances (PFAS) are associated with many adverse health conditions. Among the main effects is carcinogenicity in humans, which deserves to be further clarified. An evident association has been reported for kidney cancer and testicular cancer. In 2013, a large episode of surface, ground and drinking water contamination with PFAS was uncovered in three provinces of the Veneto Region (northern Italy) involving 30 municipalities and a population of about 150,000. We report on the temporal evolution of all-cause mortality and selected cause-specific mortality by calendar period and birth cohort in the local population between 1980 and 2018. Methods The Italian National Institute of Health pre-processed and made available anonymous data from the Italian National Institute of Statistics death certificate archives for residents of the provinces of Vicenza, Padua and Verona (males, n = 29,629; females, n = 29,518) who died between 1980 and 2018. Calendar period analysis was done by calculating standardised mortality ratios using the total population of the three provinces in the same calendar period as reference. The birth cohort analysis was performed using 20–84 years cumulative standardised mortality ratios. Exposure was defined as being resident in one of the 30 municipalities of the Red area, where the aqueduct supplying drinking water was fed by the contaminated groundwater. Results During the 34 years between 1985 (assumed as beginning date of water contamination) and 2018 (last year of availability of cause-specific mortality data), in the resident population of the Red area we observed 51,621 deaths vs. 47,731 expected (age- and sex-SMR: 108; 90% CI: 107–109). We found evidence of raised mortality from cardiovascular disease (in particular, heart diseases and ischemic heart disease) and malignant neoplastic diseases, including kidney cancer and testicular cancer. Conclusions For the first time, an association of PFAS exposure with mortality from cardiovascular disease was formally demonstrated. The evidence regarding kidney cancer and testicular cancer is consistent with previously reported data.

Abstract Introduction Ovarian and pleural cancer are causally associated with asbestos exposure. In a previous study in Lombardy, Northern Italy (about 10 million people), we found evidence of a spatial correlation between pleural and ovarian cancer mortality. In this study, we estimated cases and fractions of ovarian cancer deaths attributable to asbestos exposure by including a third disease, breast cancer, which is unrelated to asbestos but shares with ovarian cancer other risk factors (including reproductive and lifestyle determinants). Methods We formulate a trivariate Bayesian joint disease model to extract information on attributable fraction from the geographic distribution of ovarian, pleural, and breast cancer mortality at municipality level in the Lombardy Region (Italy) from 2000 to 2018. Expected cases were calculated by indirect internal standardization. Results We found shared dependencies between ovarian and pleural cancer, which capture asbestos exposure, and a spatially structured clustering component shared between ovarian and breast cancer, capturing other risk factors. Overall, we counted 10,462 ovarian cancer deaths, of which 574 (95% Credibility Interval 388-819) were estimated to be attributable to asbestos (attributable fraction 5.5% 95% Credibility Interval 3.7-7.8). In some municipalities, we found attributable fractions in the 33-47% range. Discussion These results are consistent with known heavy asbestos pollution and high pleural cancer mortality in some areas of the region. Conclusion The impact of asbestos can be relevant but may go unnoticed when the background risk of ovarian cancer is low. Bayesian modelling provides helpful information in such context, and it is useful to tailor epidemiological surveillance.

ObjectivesWe aimed to estimate the fraction of deaths from ovarian cancer attributable to asbestos exposure in Lombardy Region, Italy, using a novel approach that exploits the fact that ovarian cancer asbestos exposure is associated with pleural cancer and other risk factors for breast cancer.MethodsThis ecological study is based on the Italian National Institute of Statistics mortality data. We formulate a trivariate Bayesian joint disease model to estimate the attributable fraction (AF) and the number of ovarian cancer deaths attributable to asbestos exposure from the geographic distribution of ovarian, pleural and breast cancer mortality at the municipality level from 2000 to 2018. Expected deaths and standardised mortality ratios were calculated using regional rates.ResultsWe found shared dependencies between ovarian and pleural cancer, which capture risk factors common to the two diseases (asbestos exposure), and a spatially structured clustering component shared between ovarian and breast cancer, capturing other risk factors. Based on 10 462 ovarian cancer deaths, we estimated that 574 (95% credibility interval 388–819) were attributable to asbestos (AF 5.5%; 95% credibility interval 3.7–7.8). AF reaches 34%–47% in some municipalities with known heavy asbestos pollution.ConclusionsThe impact of asbestos on ovarian cancer occurrence can be relevant, particularly in areas with high asbestos exposure. Estimating attributable cases was possible only by using advanced Bayesian modelling to consider other risk factors for ovarian cancer. These findings are instrumental in tailoring public health surveillance programmes and implementing compensation and prevention policies.