A comparative study of the disease burden attributable to asbestos in Brazil, China, Kazakhstan, and Russia between 1990 and 2019

Our plain-English summary of A comparative study of the disease burden attributable to asbestos in Brazil, China, Kazakhstan, and Russia between 1990 and 2019, by J. Chen, C. Wang, J. Zhang, et al (BMC Public Health, 2022).

The study

• Authors: J. Chen, C. Wang, J. Zhang, T. Zhang, H. Liang, S. Mao, H. Li, Z. Wang
• Journal: BMC Public Health
• Published: 2022;22(1):2012
• Cited by: 15 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Brazil, China, Kazakhstan, and Russia are the main asbestos-producing countries, and all forms of asbestos are carcinogenic to humans. The objective of this study was to estimate the disease burden attributable to asbestos between 1990 and 2019 in major producing countries, including Brazil, China, Kazakhstan, and Russia.

Methods: Age-standardized mortality rates (ASMR) and age-standardized disability-adjusted life year (DALY) rates (ASDR) of disease burden attributable to asbestos by country, age, and sex were extracted from the Global Burden of Disease 2019. Percentage change and estimated annual percentage change (EAPC) were used to assess the trends of ASDR and ASMR of disease burden attributable to asbestos between 1990 and 2019.

Results: Asbestos-related diseases were highly heterogeneous across Global, Brazil, China, Kazakhstan, and Russia. There was a downward trend in ASMR and ASDR of diseases burden related to asbestos globally. The age-specific mortality rate of disease attributable to asbestos increased in men and women, although it decreased in women aged 85-89, the highest age-specific mortality rate were observed in age 95 + group in men [162.14 (95% UI: 103.76-215.45)] and women [30.58 (95% UI: 14.83-44.33)] per 100 000 population, respectively. Tracheal, bronchus, and lung (TBL) cancer was the leading cause of death and DALYS attributable to asbestos between 1990 and 2019 globally and in Brazil, China, Kazakhstan, and Russia. China had the highest percentage change (73.31%) and EAPC [3.41 (95% CI: 2.75-4.08)] in ASMR related to exposure to asbestos in men, with the highest percentage change (73.31%) and EAPC [3.41 (95% CI: 2.75-4.08)] in ASDR in men.

Conclusions: The ASMR and ASDR of disease burden attributable to asbestos decreased between 1990 and 2019 globally. TBL cancer was the leading cause of death and DALYs attributable to asbestos between 1990 and 2019. There has been an increasing trend in mortality and DALYs globally, especially in older men. The burden of disease attributable to asbestos is increasing in China, especially in men.

© 2022. The Author(s).

In plain English

The authors analysed existing Global Burden of Disease (GBD) 2019 estimates of deaths and disability-adjusted life years (DALYs, a measure of healthy life lost) attributed to occupational exposure to asbestos. They covered the world, Brazil, China, Kazakhstan and Russia, from 1990 to 2019. GBD links five diseases to this exposure: tracheal, bronchus and lung (TBL) cancer, pneumoconiosis, ovarian cancer, mesothelioma and larynx cancer. Worldwide, the age-standardized death rate in 2019 was 3.05 per 100,000 population (95% uncertainty interval 2.29 to 3.82), 23.17% lower than in 1990. The global age-standardized DALY rate fell 31.27%. TBL cancer was the leading cause in all five settings, followed by mesothelioma. In China, the age-standardized death rate for both sexes rose from 0.92 (0.62 to 1.38) to 1.47 (0.98 to 2.13) per 100,000, a change of 59.78%. Among Chinese men it rose 87.59%, the largest increase among the four countries. Men in Kazakhstan had the largest decrease (48.62%). The authors noted that GBD figures are model estimates, not real observations, and could be inaccurate. They called for a global asbestos ban, especially in these four countries.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Descriptive trend analysis of existing modelled estimates from the Global Burden of Disease 2019 study, using percentage change and estimated annual percentage change (EAPC)
• Who was studied: Populations of the whole world (Global), Brazil, China, Kazakhstan and Russia, 1990 to 2019, by sex and age, as estimated in GBD 2019
• Exposure: Occupational exposure to asbestos as defined in GBD 2019, linked to five diseases: tracheal, bronchus and lung (TBL) cancer, pneumoconiosis, ovarian cancer, mesothelioma and larynx cancer. The data analysis does not separate fiber types, and mesothelioma is not divided by site.
• Main results:
  • Globally (both sexes), the 2019 age-standardized mortality rate attributable to asbestos was 3.05 (95% UI 2.29 to 3.82) per 100,000 and the age-standardized DALY rate was 51.77 (95% UI 38.71 to 65.65) per 100,000. These were decreases of 23.17% and 31.27% from 1990.
  • TBL cancer was the leading cause of asbestos-attributable deaths and DALYs from 1990 to 2019 globally and in all four countries, followed by mesothelioma.
  • In China (both sexes), the age-standardized mortality rate rose from 0.92 (95% UI 0.62 to 1.38) per 100,000 in 1990 to 1.47 (95% UI 0.98 to 2.13) in 2019, a percentage change of 59.78% (EAPC 2.80, 95% CI 2.24 to 3.36).
  • Among men, China had the highest percentage change in age-standardized mortality rate: 87.59%, EAPC 3.69 (95% CI 3.01 to 4.37).
  • Among men, China also had the highest percentage change in age-standardized DALY rate: 73.31%, EAPC 3.41 (95% CI 2.75 to 4.08).
  • Among men, Kazakhstan had the largest decrease in age-standardized mortality rate: -48.62%, EAPC -3.09 (95% CI -3.74 to -2.44).
  • In 2019, Russia and Kazakhstan ranked top two among men for asbestos-attributable mortality and DALY rates. Among women, Brazil ranked first.
  • Globally in 2019, the highest age-specific mortality rates were in the 95+ age group: 162.14 (95% UI 103.76 to 215.45) per 100,000 in men and 30.58 (95% UI 14.83 to 44.33) per 100,000 in women.
• The authors' conclusion: The authors concluded that the asbestos-attributable burden declined globally but varied widely across the four countries and was rising in China. They called for a global asbestos ban, especially in Brazil, China, Kazakhstan and Russia.
• Limitations the authors state:
  • The risk could not be quantified because epidemiological studies lack accurate exposure information.
  • GBD results are model-based estimates rather than real observed data and could be inaccurate.
  • Asbestos prevalence may be underestimated in low-income countries with poor health supervision systems.

Topics

Medical terms in this study, explained in our Lexicon: Carcinogenic, Bronchus.

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• The global burden of cancers attributable to occupational factors, 1990-2021 — B. Zou, P. Wu, et al. (2025)
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• Global and regional burden of disease and injury in 2016 arising from occupational exposures: a systematic analysis for the Global Burden of Disease Study 2016 — GBD 2016 Occupational Risk Factors Collaborators (2020)

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