1. Cause - specific morbidity study of a population exposed to 50 Hz magnetic fields Lucia Fazzo 1, Valeria Tancioni 2, Nicola Vanacore 3, Paolo Papini 2, Ivano Iavarone 1, Sara Farchi 2, Caterina Bruno 1, Alessandro Polichetti 4, Piero Borgia 2, Pietro Comba 1 1) Istituto Superiore di Sanità, Dept. of Environment and Primary Prevention, Rome, Italy 2) Latium Region Agency for Public Health, Rome, Italy 3) Istituto Superiore di Sanità, National Centre for Epidemiology, Surveillance and Health Promotion, Rome, Italy 4) Istituto Superiore di Sanità, Dept. of Technology and Health, Rome, Italy ISEE/ISEA Conference Paris, France, sept. 2-6, 2006

2. FOREWORD Extremely low frequency (essentially 50/60 Hz) magnetic fields have been categorized by IARC (2002) as “Possibly carcinogenic to humans” (Group 2B) The authors of two pooled analyses of case-control studies on childhood leukemia and magnetic field exposure (Ahlbom et al, 2000; Greenland et al, 2000) have recommended to conduct future studies in populations exposed to relatively high exposure levels (approximetely, > 0.4-0.5 microtesla) In this context ISS designed the “Longarina” project, an epidemiologic study on a district of Ostia Antica (Rome) built in the fifties under a 60 kV distribution line

4. EVALUATION OF MAGNETIC FIELD EXPOSURE Spot and long term measurements of magnetic induction with Emdex Lite equipment produced by Enertech Consultants Theoretical evaluation was performed by CAMPI software (Dr. Daniele Andreuccetti of “Nello Carrara” Institute of Applied Physic of National Research Council in Florence), based on geometric configuration of electric line and current data from 1/1/1995 to 30/9/2004, both provided by ACEA SpA, and distance of dwellings from the line

5. CURRENT LOAD ON AUGUST 4th 2004 MAGNETIC INDUCTION MEASURED ON AUGUST 4th 2004

6. THE STUDY POPULATION: THE STUDY POPULATION: INCLUSION CRITERIA INCLUSION CRITERIA All subjects resident in any period between 1954 and 2003 in an area 100 meters right and left of the power line: 357 subjects We defined three sub-cohorts, based on the distance from the line and on the estimated exposure level: from the line and on the estimated exposure level: A) the residents in dwellings closest to the line (0-28 mt), completely exposed above 0,4 µT (value estimated for an electric completely exposed above 0,4 µT (value estimated for an electric current of 389 A, the maximum value registered in the last years) current of 389 A, the maximum value registered in the last years) R) the residents in dwellings farthest from the line (33-100 mt), completely exposed below 0,33 µT (389 A) (33-100 mt), completely exposed below 0,33 µT (389 A) B) the residents in dwellings with parts of the buildings at intermediate distances from the line, at intermediate distances from the line, not satisfying the inclusion criteria of A and R not satisfying the inclusion criteria of A and R

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8. MORTALITY STUDY Follow-up: 1980-2003; reference population: Region Results: All-causes mortality of the cohort did not differ from expected values (SMR 0.99, 95%CI: 0.73-1.35; 40 obs.) All cancer mortality showed a non-significant increase (SMR 1.34, 95%CI: 0.82- 2.18; 16 obs.), that reached statistical significance in the analyses limited to subjects with more than 30 years of residence (SMR 2.09; 8 obs.), or of latency (SMR 2.24; 9 obs). All cancer mortality was highest in the subcohort closest to the power line (0- 28 meters) and exposed to highest levels of magnetic field (SMR 1.94, 95%CI: 0.97-3.88; 8 obs). A significantly increased risk for digestive tract neoplasms (SMR 3.57; 5 obs) was observed, which was mainly caused by pancreatic cancer (SMR 8.19; 4 obs). Mortality from lymphohaematopoietic malignancies was increased based on two cases of leukemia (SMR 2.10, 95%CI: 0.53-8.41; 2 obs). Fazzo et al, Epidemiol Prev 2005; 29:243-252

9. MORBIDITY STUDY Objective: Objective: To investigate the occurrence of nonfatal diseases and to have access to hospital discharge files which are more accurate than death certificates Methods: Methods: We analyzed the hospital discharge records of Latium Region for cohort members, from 1st January, 1998 through 31st December, 2003 (331 subjects) We considered the first-visit hospital discharge record for selected causes of each subject, subsequent to the beginning of residence in the study area Standardized morbidity ratios (SMR’s), using regional population as reference, were computed, with 95% Confidence Intervals

10. MORBIDITY STUDY: RESULTS 1 We found 83 first-visit hospital discharge cards of study subjects All cancer All cancer :  non-statistically significant increase in the overall cohort (SMR 1.25, 95%CI: 0.85-1.83; 26 obs.)  significant increase among the subjects closest (0-28 mt) to the line (SMR 1.94; 16 obs) Primary neoplasms Primary neoplasms :  non-statistically significant increase in the overall cohort (SMR 1.61, 95%CI: 0.98-2.62; 16 obs)  significant increase among subjects with more than 30 years of residence (SMR 1.96; 10 obs) and latency (SMR 1.94; 11 obs)  significant increase among subjects closest (0-28mt) to the line (SMR 2.29; 9 obs) Pancreatic cancer : significant increase among men (SMR 16; 2 obs)  significant increase among men (SMR 16; 2 obs)  significant increase among the subjects closest (0-28 mt) to the line (SMR 23; 2 obs)

11. MORBIDITY STUDY: RESULTS 2 Secondary and unspecified neoplasms:  significant increase among men in the overall cohort (SMR 4.77; 4 obs)  significant increase among the subjects closest (0-28 mt) to the line (SMR 6.20; 4 obs) Haematological diseases: significant increase in the overall cohort (SMR 3.13; 6 obs.)  significant increase in the overall cohort (SMR 3.13; 6 obs.)  significant increase among subjects with more than 30 years of residence (SMR 5.39; 4 obs) and latency (SMR 5.80; 5 obs) (SMR 5.39; 4 obs) and latency (SMR 5.80; 5 obs) Ischaemic heart disease: significant increase among the subjects closest (0-28 mt) to the line  significant increase among the subjects closest (0-28 mt) to the line (SMR 2.82; 6 obs) (SMR 2.82; 6 obs)

12. CONCLUDING REMARKS The findings of mortality and morbidity studies, The findings of mortality and morbidity studies, even if based on a small number of subjects, support the hypothesis of an anomaly in the health status of the study population, in particular among subjects with the longest residence and latency (more than 30 years), and among those resident closest (0-28 mt) to the power line Further evaluation of these findings, together with those of an on-going cross-sectional health survey, Further evaluation of these findings, together with those of an on-going cross-sectional health survey, will help us to gain deeper insight In the meanwhile, suitable locations for replicating In the meanwhile, suitable locations for replicating the study are being researched; a pilot study in a district of Pisa is currently in progress

13. Thank you for your attention. Thanks to my colleagues, to the whole community involved in this research, and especially to the local Committee “against the power line”