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Original Research |

Asbestos and Smoking as Risk Factors for Idiopathic Retroperitoneal Fibrosis: A Case–Control StudyAsbestos and Smoking in Retroperitoneal Fibrosis

Matteo Goldoni, PhD*; Silvia Bonini, MD*; Maria L. Urban, MD; Alessandra Palmisano, MD; Giuseppe De Palma, MD, PhD; Elisa Galletti, MD; Marco Coggiola, MD; Carlo Buzio, MD; Antonio Mutti, MD; and Augusto Vaglio, MD, PhD
[+] Article, Author, and Disclosure Information

* Drs. Goldoni and Bonini contributed equally to this work.

From Italian Workers' Compensation Authority Research Centre, University of Parma, and University Hospital, Parma and University of Brescia, Brescia, Italy.

Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M13-2648.

Reproducible Research Statement:Study protocol, statistical code, and data set: Available from Dr. Goldoni (e-mail, matteo.goldoni@unipr.it).

Requests for Single Reprints: Augusto Vaglio, MD, PhD, Unità Operativa di Nefrologia, Azienda Ospedaliero-Universitaria di Parma, Via Gramsci 14, 43126 Parma, Italy; e-mail, augusto.vaglio@virgilio.it.

Current Author Addresses: Drs. Goldoni, Bonini, Galletti, Coggiola, and Mutti: Medicina del Lavoro, Dipartimento di Medicina Clinica e Sperimentale, Università degli Studi di Parma, Via Gramsci 14, 43126 Parma, Italy.

Drs. Urban, Palmisano, Buzio, and Vaglio: Unità Operativa di Nefrologia, Azienda Ospedaliero-Universitaria di Parma, Via Gramsci 14, 43126 Parma, Italy.

Dr. De Palma: Dipartimento di Specialità Mediche e Chirurgiche, Scienze Radiologiche e Salute Pubblica, Sezione di Salute Pubblica, Scienze Umane, Medicina del Lavoro e Igiene Industriale, Università degli Studi di Brescia, Piazzale Spedali Civili, 1-25123 Brescia, Italy.

Author Contributions: Conception and design: M. Goldoni, M.L. Urban, A. Palmisano, G. De Palma, E. Galletti, C. Buzio, A. Mutti, A. Vaglio.

Analysis and interpretation of the data: M. Goldoni, S. Bonini, G. De Palma, A. Mutti, A. Vaglio.

Drafting of the article: M. Goldoni, S. Bonini, A. Vaglio.

Critical revision of the article for important intellectual content: M. Goldoni, G. De Palma, C. Buzio, A. Mutti, A. Vaglio.

Final approval of the article: M. Goldoni, G. De Palma, C. Buzio, A. Mutti, A. Vaglio.

Provision of study materials or patients: S. Bonini, M.L. Urban, A. Palmisano, G. De Palma, E. Galletti, C. Buzio, A. Vaglio.

Statistical expertise: M. Goldoni.

Administrative, technical, or logistic support: C. Buzio, A. Mutti.

Collection and assembly of data: M. Goldoni, S. Bonini, M.L. Urban, A. Palmisano, E. Galletti, M. Coggiola, C. Buzio, A. Vaglio.

Ann Intern Med. 2014;161(3):181-188. doi:10.7326/M13-2648
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Background: Idiopathic retroperitoneal fibrosis (RPF) is a rare disease. Asbestos exposure has been proposed as a risk factor for idiopathic RPF.

Objective: To investigate the role of asbestos and other occupational agents (such as silica, metals, and organic solvents), as well as environmental agents (such as smoking), and their interactions as potential risk factors for idiopathic RPF.

Design: Case–control study.

Setting: National referral hospital for idiopathic RPF.

Patients: 90 patients with idiopathic RPF and 270 control participants matched for age, sex, and region of residency.

Measurements: Occupational history was obtained using structured questionnaires administered by blinded specialists in occupational medicine. Exposure to nonoccupational agents and presence of diseases that were potentially predisposing to idiopathic RPF were assessed through patient interviews and examination of medical records.

Results: A history of asbestos exposure was associated with idiopathic RPF (odds ratio [OR], 4.22 [95% CI, 2.14 to 8.33]). Both current smoking (OR, 3.21 [CI, 1.46 to 7.07]) and former smoking (OR, 2.93 [CI, 1.39 to 6.14]) were more prevalent among patients than among those who never smoked. A multiplicative effect was found between tobacco smoke and both occupational asbestos exposure (OR, 12.04 [CI, 4.32 to 38.28]) and extraoccupational asbestos exposure (OR, 8.42 [CI, 2.77 to 30.58]).

Limitation: Retrospective, questionnaire-based assessment of occupational exposure.

Conclusion: Exposure to asbestos and tobacco smoke resulted in strong risk factors for idiopathic RPF. Coexposure to asbestos and smoke had a multiplicative effect on risk compared with single exposure.

Primary Funding Source: None.


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Appendix Figure 1.

Study flow diagram: referral patterns and selection of patients with RPF for enrollment.

RPF = retroperitoneal fibrosis.

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Appendix Figure 2.

Study flow diagram: selection and enrollment of control participants.

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Coexposure to asbestos and smoking.

The ORs (95% CIs) were calculated by using exact conditional logistic regression models and were weighted for obesity, ischemic heart disease, and diabetes. OR = odds ratio. Top. The effect of coexposure to asbestos (occupational) and smoking on OR were both considered as dichotomous variables. Extraoccupational exposure was combined in the control group. The baseline for comparison was exposure to neither asbestos nor smoking (86 control participants and 10 case participants; OR, 1.00). Bottom. Asbestos exposure was considered as either extraoccupational or occupational. Obesity was omitted to make the models feasible with commercially available software. The baseline for comparison was exposure to neither asbestos nor smoking (62 control participants and 6 case participants; OR, 1.00).

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