Supplementary Material

Table S1. Recent epidemiological studies addressing or suggesting the relationship between environmental risk factors and human health in the Region First author & Study design Data sources Outcome Summary of findings year of publ. The decline observed in SMR between 1998 and 2009 in men of and provinces was less marked compared with males from Crispo A et Geographical ISTAT, Naples and Trend of mortality overall. Focusing on men aged 65 and older, the al., 2013 study Caserta provinces (APC) 1988-2009 decline in cancer mortality found for Italy overall diverged from the slight increase emerged from the metropolitan area of interest. Scientific evidence Cancer mortality Association between waste exposure and health on waste exposure (overall and site Barba M et al., outcomes in specific areas of Campania Region, Review and health specific) and 2011 where improper waste management and illegal outcomes in congenital waste trafficking have been documented. Campania region malformations SENTIERI ISTAT 77 Comuni All-cause Significant SMR and adjusted for deprivation Geographical Project ISS, Campania Region mortality, cancer (SMR ID) for the main causes of death (cancers, study 2014 (SIN) mortality cardiovascular diseases, etc.) The Regional Agency for Environmental Protection Municipalities along the border between the A synthetical- Musmeci L et Geographical (ARPAC) has provinces of Naples and Caserta and located on waste index al., 2010 study identified and the Tyrrhenian coast are exposed to higher waste - (SWRI) characterized the related health risk. various authorized/ unauthorized dumping sites. Significant excess relative risks (ERR, %) for all- Mortality data from cause mortality in men and women; increased All-cause ISTAT (1994-2001) risks in both genders for all cancer mortality and mortality, cancer Martuzzi M et Geographical for 196 liver cancer; significantly increased risks for mortalities and al., 2009 study municipalities of stomach and lung cancer in men only. Significant congenital the prov. of Naples ERRs also found for malformations of the anomalies and Caserta urogenital system and of the central nervous system. Significant clustering of mortality by specific ISTAT, Naples and Cancer mortality, cancers (lung, liver, gastric, kidney and bladder) Fazzo L et al., Geographical Caserta provinces congenital and prevalence of total and specific malformations 2008 study (1994-2001) anomalies in the northern part of Naples and southern part of Caserta provinces. Distribution of Significantly increased rates of all cause-mortality, cancer mortality Comba P et ISTAT, Naples and cancer mortality and congenital malformations in Geographical and birth defects al., Caserta provinces the southeastern part of the province of Caserta study in the Provinces of 2006 (1994-2001) and in the northwestern part of the and Naples. Caserta ARPAC and IZSM Soils exceeding the regulatory limit for dioxins dat (Environment Dioxin's risk in the were found in 5 Municipalities (one sample). In 45 Menegozzo M and food Dossier Municipalities of Municipalities livestock used for food production et al., 2008 monitoring) Campania exceeds the limits (one or more samples for each Provinces of Naples Municipality). and Caserta WHO, CNR, Waste Development of Agreement with the results of epidemiological ISS, Regione processing: Data organized in a synthetic studies (already carried out) and the geographical Campania impact on GIS (dal 2004) indicators of waste distribution of the IRSC at municipality level. 2008 human health danger (IRSC) Exposure to De Felipe, Di Individual blood several organic Epidemiologi Domenico A sample and inorganic Different results: significant and /or not significant cal study of (Ed.) 2010. (male+female), and contaminants in according to organic and inorganic contaminants biomonit. SEBIOREC 62 milk samples biological samples (see pag. 47-63) (2007-2010) Final Report from primiparous. from healthy donors