Analysis of Mortality from Asbestos-Related Diseases in Brazil Using Multiple Health Information Systems, 1996-2017

Our plain-English summary of Analysis of Mortality from Asbestos-Related Diseases in Brazil Using Multiple Health Information Systems, 1996-2017, by E. Algranti, V.S. Santana, F. Campos, et al (Safety and Health at Work, 2022).

The study

• Authors: E. Algranti, V.S. Santana, F. Campos, L. Salvi, C.A. Saito, F. Cavalcante, H.R. Correa-Filho
• Journal: Safety and Health at Work
• Published: 2022;13(3):302-307
• Cited by: 7 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: In Brazil, asbestos was intensively used from the 1960s until its ban in 2017. Mesothelioma, asbestosis, and pleural plaques are typical asbestos-related diseases (ARD-T). To create an ARD-T national database, death records from 1996-2017 were retrieved from several health information systems (HIS).

Methods: All national HIS containing coded diagnoses (ICD-10) and death information were obtained. Linkage was performed to create a single database of ARD-T death records, either as underlying or contributory causes, in adults aged 30 years and older.

Results: A total of 3,057 ARD-T death records were found, 2,405 (76.4%) of which being malignant mesotheliomas (MM). Pleural MM (n = 1,006; 41.8%) and unspecified MM (n = 792; 32.9%) prevailed. Male to female MM ratio (M:F) was 1.4:1, and higher ratios were found for non-malignant ARD-T: 3.5:1 for asbestosis and 2.4:1 for pleural plaques. Male crude annual mesothelioma mortality (CMmm x1,000,000) was 0.98 in 1996 and 2.26 in 2017, a 131.1% increment, while for females it was 1.04 and 1.25, a 20.2% increase, correspondingly. The small number of deaths with asbestosis and pleural plaques records precluded conclusive interpretations.

Conclusions: Even with the linkage of several HIS, ARD-T in death records remained in low numbers. MM mortality in men was higher and showed a rapid increase and, along with non-malignant ARD-T, higher M:F ratios suggested a predominant pattern of work-related exposure. The monitoring of workplace and environmental asbestos exposure needs to be improved, as well as the workers surveillance, following the recent Brazilian ban.

© 2022 Occupational Safety and Health Research Institute.

In plain English

This descriptive study counted deaths in Brazil from 1996 to 2017, among adults aged 30 or older, that were recorded with malignant mesothelioma, asbestosis or pleural plaques, whether as the underlying or a contributing cause. The authors linked five national health information systems and records from three specialized occupational respiratory clinics. They found 3,057 such deaths. Of these, 2,405 had mesothelioma recorded, most often coded as pleural (1,006) or unspecified (792), and 652 had asbestosis or pleural plaques. Men outnumbered women 1.4 to 1 for mesothelioma, 3.5 to 1 for asbestosis and 2.4 to 1 for pleural plaques. Among men, crude mesothelioma mortality rose from 0.98 to 2.26 per million inhabitants, an increase of 130.6%. Among women it rose from 1.04 to 1.25 per million, an increase of 20.2%. Numbers for asbestosis and pleural plaques were too small for firm conclusions. The authors concluded that the higher male-to-female ratios suggested mainly work-related exposure. They noted that except for the clinic records, diagnoses could not be checked for accuracy, and that not every case was likely recovered.

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 national mortality study using probabilistic linkage of anonymous health information system records; no statistical tests
• Who was studied: All death records in Brazil, 1996 to 2017, of adults aged 30 years or older with a coded typical asbestos-related disease (mesothelioma, asbestosis, pleural plaques) as underlying or contributory cause, drawn from five national health information systems plus a repository from three specialized clinics
• Exposure: Individual asbestos exposure was not measured. The study counted disease records only and did not report fiber types or jobs.
• Main results:
  • 3,057 deaths had a typical asbestos-related disease recorded, as either underlying or contributory cause
  • Of 2,405 mesothelioma deaths, 1,006 (41.8%) were coded as pleural
  • Of 2,405 mesothelioma deaths, 792 (32.9%) were coded as unspecified
  • 652 deaths had non-malignant disease (asbestosis or pleural plaques) recorded
  • Male to female ratio: 1.62:1 for all typical asbestos-related diseases and 1.4:1 for mesothelioma
  • Male to female ratio for asbestosis was 3.54 (372 asbestosis deaths in total)
  • Pleural plaques: 280 deaths (198 men, 82 women), male to female ratio 2.41
  • Peritoneal mesothelioma made up 22.9% of mesothelioma deaths in women and 13.2% in men
  • 46.3% of male and 52.7% of female mesothelioma deaths were in people aged 64 or older
  • Overall crude mesothelioma mortality rose from 0.94 per million inhabitants in 1996 to 1.82 per million in 2017, a 93.6% increase, averaging 4.4% a year
  • Men: crude mesothelioma mortality rose from 0.98 to 2.26 per million (peak 2.82 per million in 2011), an increase of 130.6%, averaging 6.2% a year
  • Women: crude mesothelioma mortality rose from 1.04 per million in 1996 to 1.25 in 2017, an increase of 20.2%, averaging 1.0% a year
  • Mortality estimates for asbestosis and pleural plaques were too small for firm conclusions
  • For 1996 to 2010, linkage found 1,833 deaths with mesothelioma records, compared with 976 reported by an earlier study that used death certificates only (an 87% increment)
• The authors' conclusion: The authors concluded that mesothelioma mortality was higher in men and rising quickly. Together with the non-malignant diseases, the higher male-to-female ratios suggested a mainly work-related pattern of exposure. Even with linkage, numbers stayed low, and the authors expected these deaths to grow in coming decades.
• Limitations the authors state:
  • Except for the clinic repository, where clinical data were available, diagnoses came only from database records and their accuracy could not be checked
  • Death records could not be compared with clinical notes for individual cases
  • Many sociodemographic data were missing, so conclusions about skin color and schooling may be compromised
  • Rare diagnoses such as mesothelioma had low accuracy in the public hospital database (SIH-SUS), according to an earlier study the authors cite
  • Not all cases were likely recovered, because only recognized and registered diagnoses were captured
  • ICD-10 coding does not separate out pleural thickening
  • Small numbers limited interpretation for pericardial mesothelioma

Topics

Medical terms in this study, explained in our Lexicon: Mesothelioma, Pleural Plaques, Malignant Mesothelioma, Asbestos Exposure.

Related studies

• Correction: Saito et al. Sex-Specific Mortality from Asbestos-Related Diseases, Lung and Ovarian Cancer in Municipalities with High Asbestos Consumption, Brazil, 2000-2017. Int. J. Environ. Res. Public Health 2022, 19, 3656 — C.A. Saito, M.A. Bussacos, et al. (2022)
• Sex-Specific Mortality from Asbestos-Related Diseases, Lung and Ovarian Cancer in Municipalities with High Asbestos Consumption, Brazil, 2000-2017 — C.A. Saito, M.A. Bussacos, et al. (2022)
• The next mesothelioma wave: mortality trends and forecast to 2030 in Brazil — E. Algranti, C.A. Saito, et al. (2015)
• The Brazilian System for Monitoring Workers and General Population Exposed to Asbestos: Development, Challenges, and Opportunities for Workers' Health Surveillance — R.J. Buralli, R.D.C. Pinheiro, et al. (2023)
• Asbestos and health in the Third World: the case of Brazil — D.M. Berman (1986)
• Health implications of atmospheric aerosols from asbestos-bearing road pavements traditionally used in Southern Brazil — R.H.M. Godoi, S.J. Gonçalves, et al. (2016)

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