Asbestos Exposure and the Mesothelioma Incidence in Poland

Our plain-English summary of Asbestos Exposure and the Mesothelioma Incidence in Poland, by M. Krówczyńska, E. Wilk (International Journal of Environmental Research and Public Health, 2018).

The study

• Authors: M. Krówczyńska, E. Wilk
• Journal: International Journal of Environmental Research and Public Health
• Published: 2018;15(8)
• Cited by: 9 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Unlabelled: Asbestos is carcinogenic to humans; the exposure to asbestos causes a wide range of diseases.

Aim: Malignant mesothelioma (MM) is unique for asbestos exposure.

Methods: Based on the physical inventory of asbestos-cement roofing, the social-economic situation of communes, the proximity of asbestos manufacturing plants, the land use data referring to the surface of the built-up area, and the historical data on the annexations, the amount of asbestos-containing products in use was estimated by computing best Random Forest models. Per capita asbestos use is an indicator to compare the state of asbestos use among countries. MM cases in the local administrative units (provinces) were tested by the application of Moran's I and Getis and Ord statistic.

Results: The total amount of asbestos roofing in Poland was estimated at 738,068,000 m² (8.2 million tons). In total there were 28 plants in Poland located in 11 provinces throughout the country. The amount of asbestos-cement roofing in use is correlated primarily with the measurements of asbestos concentration fibers (rs = 0.597). MM raw morbidity rate was calculated, stratified by province, and classified into five groups with respect to incidence. Hotspots of MM cases are in the southern part of Poland.

Conclusions: MM cases are concentrated in the same geographical areas, which may indicate an increasing impact of environmental exposure. The results of the local and global autocorrelation clearly indicate a statistically significant relationship between incidences of MM in provinces. Poland and other Eastern European countries are among countries with low MM incidence rate. Detailed investigation is desirable since the current MM morbidity rate in Poland seems to be underestimated.

In plain English

This was a geographic study of asbestos exposure and malignant mesothelioma across the provinces of Poland. The authors used Random Forest computer models to estimate how much asbestos-cement roofing is still in use. They combined this with data on former asbestos plants, air measurements of asbestos fibers, and mesothelioma cases registered from 1999 to 2013. They estimated 738,068,000 m2 (8.2 million tons) of asbestos roofing in Poland, an average of 202 kg of asbestos-cement product per inhabitant. There had been 28 plants using asbestos, and over 90% of the asbestos used was chrysotile. Roofing in use correlated with measured fiber concentrations in the air (rs = 0.597). No statistically significant correlation was found between products in use and mesothelioma cases. Mesothelioma rates showed statistically significant clustering between provinces, with hot spots in southern Poland. Women made up 36% of cases and men 64%. The authors suggested the clustering may indicate an increasing impact of environmental exposure. They concluded that Poland's mesothelioma rate seems underestimated and needs detailed investigation.

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: Geographic (province-level) analysis combining Random Forest modelling of asbestos-cement roofing in use with spatial statistics (Moran's I, Getis-Ord) on mesothelioma registry data
• Who was studied: Malignant mesothelioma cases (ICD-10 C.45) in Poland from 1999 to 2013, from the National Cancer Register and the Amiantus Program for former asbestos plant employees, grouped by province and gender; the total number of cases is not stated
• Exposure: Asbestos-cement products still in use (mainly roofing), proximity to former asbestos manufacturing plants, and measured asbestos fiber concentrations in air. Over 90% of the asbestos used in Polish production was chrysotile and less than 10% was crocidolite and amosite.
• Main results:
  • Total asbestos roofing in Poland was estimated at 738,068,000 m2 (8.2 million tons)
  • On average, 202 kg of asbestos-cement product was still in use per inhabitant of Poland
  • 28 plants in Poland used asbestos in production, of which 10 produced asbestos-cement products
  • The amount of asbestos-cement roofing in use correlated with measured asbestos fiber concentrations in the air (rs = 0.597)
  • The highest average air concentration was 8229 fibers per m3, in Annopol (Lubelskie)
  • Three provinces (Śląskie, Małopolskie and Świętokrzyskie) had the highest cumulative mesothelioma raw morbidity rate, over 11 cases per 100,000 inhabitants
  • No statistically significant correlation was found between the number of asbestos-cement products in use and the number of mesothelioma cases
  • Statistically significant positive spatial autocorrelation of the cumulative mesothelioma morbidity rate was found. Global Moran's I values per Table 1: 0.287 (P 0.03) for the entire population, 0.260 (P 0.04) for men, 0.269 (P 0.03) for women.
  • Hot spots of mesothelioma cases were in southern Poland (Śląskie, Małopolskie, Świętokrzyskie, plus Podkarpackie for female cases). Cold spots were in Wielkopolskie for men and Dolnośląskie for women.
  • Cases in women made up 36% and cases in men 64%
  • The authors interpreted the finding that cases in men, women and the general population were concentrated in the same areas as possibly indicating an increasing impact of environmental exposure
  • Using WHO Mortality Database data, Poland had the lowest mesothelioma mortality rate compared to the Western European countries shown
• The authors' conclusion: The authors concluded that the current mesothelioma morbidity rate in Poland seems to be underestimated, particularly compared with Western European countries in terms of asbestos use per capita, and that detailed investigation is needed
• Limitations the authors state:
  • Only a raw (not age-adjusted) morbidity rate could be used, because data on cases by age group were lacking
  • Without data on asbestos products in use in other countries, it is difficult to project future cases or to judge whether current case numbers are high or low
  • The authors suggested the lack of correlation between products in use and mesothelioma may reflect the long latency period

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: Asbestos Exposure, Mesothelioma, Carcinogenic, Malignant Mesothelioma, Asbestos-Cement, Environmental Exposure, Incidence.

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