Asbestos Consumption and Malignant Mesothelioma Mortality Trends in the Major User Countries

Our plain-English summary of Asbestos Consumption and Malignant Mesothelioma Mortality Trends in the Major User Countries, by C. Gariazzo, A. Gasparrini, A. Marinaccio (Annals of Global Health, 2023).

The study

• Authors: C. Gariazzo, A. Gasparrini, A. Marinaccio
• Journal: Annals of Global Health
• Published: 2023;89(1):11
• Type of article: Meta-analysis
• Cited by: 23 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: The causal association between mesothelioma and asbestos exposure is conclusive, and many studies have proved that the trend in asbestos use is a strong predictor of the pattern in mesothelioma cases with an adequate latency time (generally around 30-40 years or more). Recently, a novel approach for predicting malignant pleural mesothelioma, based on asbestos consumption trend and using distributed non-linear models, has been applied.

Objectives: The purpose of this study is to analyse trends in asbestos consumption and malignant mesothelioma mortality in the major asbestos-user countries. Furthermore, we applied distributed non-linear models to estimate and compare epidemiological relationships between asbestos consumption and mesothelioma mortality across these countries.

Methods: The study involves major asbestos-user countries in which historical asbestos consumption and mesothelioma mortality data are available. Data on asbestos consumption were derived from worldwide asbestos supply and mesothelioma mortality data from World Health Organization (WHO) mortality archives. A quasi-Poisson generalized linear model was used to model past asbestos exposure and male mesothelioma mortality rates in each country. Exposure-response associations have been modelled using distributed lag non-linear models.

Findings And Conclusions: According to the criteria defined above, we selected 18 countries with raw asbestos cumulative consumptions higher than two million tons in the period 1933-2012. Overall, a clear linear relationship can be observed between total consumption and total deaths for mesothelioma. Country-specific exposure, lag and age-response relationships were identified and common functions extracted by a meta-analysis procedure. Non-linear models appear suitable and flexible tools for investigating the association between mesothelioma mortality and asbestos consumption. There is a need to improve the global epidemiological surveillance of asbestos-related diseases, particularly mesothelioma mortality, and the absence of reliable data for some major asbestos-user countries is a real concern. A reliable assessment of mesothelioma mortality is a fundamental step towards increasing the awareness of related risks and the need of an international ban on asbestos.

Copyright: © 2023 The Author(s).

In plain English

This was an ecological study comparing national asbestos use with deaths from malignant mesothelioma among men. The authors selected 18 countries using US Geological Survey figures, stating that each consumed more than two million tons of raw asbestos in 1933–2012, though their table lists Belgium at 1,956,961 tons. Together they accounted for 79% of world consumption. Mesothelioma deaths for 1998–2017 came from the World Health Organization mortality database. Russia, China and India reported no mesothelioma deaths there, Brazil had only partial data, and Thailand reported 31 male deaths. Across countries, total consumption and total mesothelioma deaths showed a clear linear relationship. Models for 12 countries showed high heterogeneity between them. Pooled results showed risk rising with consumption level, and almost linearly for about 20 years after exposure. The USA alone saw deaths fall in the last period (13,056 in 2008–2012, 12,659 in 2013–2017). The authors concluded that global surveillance of mesothelioma needs improving. They noted that national consumption is only a stand-in for exposure and that fiber type could not be taken into account.

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: Ecological, multi-country study. A quasi-Poisson model was fitted for each country with distributed lag non-linear models, and the country results were pooled by meta-analysis.
• Who was studied: 18 countries that the authors describe as having cumulative raw asbestos consumption above two million tons in 1933–2012. Their own Table 1, however, lists Belgium at 1,956,961 tons. The countries were Belgium, France, Germany, Italy, Poland, Russia, Spain, United Kingdom, China, India, Japan, South Korea, Thailand, Brazil, Canada, Mexico, USA and Australia. The study counted male mesothelioma deaths (ICD-10 C45) from the WHO database for 1998–2017. Modelling was restricted to 12 countries with reliable data, covering males aged 25–89.
• Exposure: National apparent asbestos consumption (domestic production plus imports minus exports) from US Geological Survey reports, converted to per capita figures for 1920–2018. All asbestos was treated as a whole, without separating fiber types or occupational and environmental sources. Exposure was assumed to be limited to working age (15–65), with lags of up to 60 years.
• Main results:
  • The 18 selected countries represented 79% of total world asbestos consumption during the study period.
  • In 1993–2012 all countries decreased asbestos consumption from the previous period except China, India and Thailand, whose consumption increased by 161%, 127% and 64% respectively.
  • Russia, China and India reported no mesothelioma deaths in the WHO database, and Brazil's data were only partial (not national).
  • Across countries, a clear linear relationship was observed between total asbestos consumption (1933–2012) and total mesothelioma deaths (1998–2017).
  • The USA was the only country with fewer male mesothelioma deaths in the last five-year period than in the one before: 13,056 in 2008–2012 and 12,659 in 2013–2017. The authors said these findings support the positive effects of asbestos bans or restrictions.
  • In the 12 modelled countries, high heterogeneity was seen between countries. The pooled exposure-response function showed risk increasing with asbestos consumption level.
  • In the pooled lag-response, calculated for an exposure of 3.9 tons per 10,000 inhabitants, the relative risk grew almost linearly for 20 years after exposure. It then dropped, which the authors said reflects the behaviour of some countries.
  • Risk by age increased slowly until age 50 and sharply after that, with large scatter between countries.
  • The country models reproduced total observed male mesothelioma cases with small bias. For example, the USA had 37,875 observed and 36,155 predicted cases in 1999–2017.
  • In the discussion, the authors wrote that historical consumption trends in China, India and Russia led to estimates of approximately 40,000, 20,000 and 50,000 expected male mesothelioma deaths respectively in 1998–2017, although none were registered. They also stated that heterogeneity between countries did not suggest the pooled curves could be directly transferred to these countries to estimate deaths reliably.
• The authors' conclusion: The authors concluded that global epidemiological surveillance of asbestos-related diseases, particularly mesothelioma mortality, needs to be improved. They also concluded that the absence of reliable data for some major asbestos-user countries is a real concern.
• Limitations the authors state:
  • National asbestos consumption was used as a proxy for exposure.
  • Asbestos mineral type (for example amphiboles such as crocidolite and amosite versus chrysotile) could not be considered because adequate data were lacking. Fiber dimensions were also not included.
  • Asbestos consumption figures and their yearly variation are highly uncertain, particularly for developing countries.
  • The large confidence intervals indicate low accuracy, likely due to imprecision in both the consumption and the mortality data.
  • An ecological study is probably an inappropriate tool for investigating mesothelioma risk by age.
  • Data were lacking from the highest-consuming countries, China, India and Russia.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Lung cancer, Mesothelioma.

Medical terms in this study, explained in our Lexicon: Malignant Mesothelioma, Mesothelioma, Asbestos Exposure, Latency, Pleural Mesothelioma, Meta-Analysis.

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• Trends and the Economic Effect of Asbestos Bans and Decline in Asbestos Consumption and Production Worldwide — L.P. Allen, J. Baez, et al. (2018)
• Trends in occupational asbestos exposure and asbestos consumption over recent decades in Korea — D. Park, S. Choi, et al. (2008)
• Predictions of mortality from pleural mesothelioma in Italy: a model based on asbestos consumption figures supports results from age-period-cohort models — A. Marinaccio, F. Montanaro, et al. (2005)
• Evolving trends in lung cancer risk factors in the ten most populous countries: an analysis of data from the 2019 Global Burden of Disease Study — C.T. Jani, S.A. Kareff, et al. (2025)

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