Asbestos in Belgium: an underestimated health risk. The evolution of mesothelioma mortality rates (1969-2009)

Our plain-English summary of Asbestos in Belgium: an underestimated health risk. The evolution of mesothelioma mortality rates (1969-2009), by L. Van den Borre, P. Deboosere (International Journal of Occupational and Environmental Health, 2014).

The study

• Authors: L. Van den Borre, P. Deboosere
• Journal: International Journal of Occupational and Environmental Health
• Published: 2014;20(2):134-40
• Cited by: 22 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Although Belgium was once a major international manufacturer of asbestos products, asbestos-related diseases in the country have remained scarcely researched.

Objectives: The aim of this study is to provide a descriptive analysis of Belgian mesothelioma mortality rates in order to improve the understanding of asbestos health hazards from an international perspective.

Methods: Temporal and geographical analyses were performed on cause-specific mortality data (1969-2009) using quantitative demographic measures. Results were compared to recent findings on global mesothelioma deaths.

Results: Belgium has one of the highest mesothelioma mortality rates in the world, following the UK, Australia, and Italy. With a progressive increase of male mesothelioma deaths in the mid-1980s, large differences in mortality rates between sexes are apparent. Mesothelioma deaths are primarily concentrated in geographic areas with proximity to former asbestos industries.

Conclusions: Asbestos mortality in Belgium has been underestimated for decades. Our findings suggest that the location of asbestos industries is correlated with rates of mesothelioma, underlining the need to avert future asbestos exposure by thorough screening of potential contaminated sites and by pursuing a global ban on asbestos.

In plain English

This descriptive study examined Belgian mesothelioma deaths from death certificates for 1969–2009. Data for 1985 and 2000–2002 were missing and were estimated by interpolation. Before 1998, when a specific mesothelioma code was introduced, the authors used pleural cancer as an indicator. They identified 3425 mesothelioma deaths (2646 males, 779 females). For 1994–2008, they compared Belgium with the ten countries reporting the most mesothelioma deaths in an earlier study by Delgermaa and colleagues. Belgium contributed eight reporting years, and the other countries' reporting years differed. Belgium's age-adjusted rate, 9.6 per million, was the fourth highest, after the United Kingdom, Australia and Italy. Belgian male deaths were 4.7 times female deaths. From 1969 to 2009, the male rate rose from 2.5 to 26.3 per million and the female rate from 1.6 to 4.1 per million. For 2005–2009, five adjacent districts where large asbestos industries were located had significantly more male deaths than expected. For women, only Mechelen and Halle-Vilvoorde did. The authors concluded that Belgian mesothelioma mortality had long been underestimated and that the location of asbestos industries is correlated with mesothelioma rates. Deaths were assigned to the district of residence at death.

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 analysis of national cause-specific mortality data from death certificates, with time-trend analysis, an international comparison, and a district-level geographic analysis (standardized mortality ratios) alongside the locations of known asbestos companies
• Who was studied: Mesothelioma deaths in Belgium, 1969–2009: 3425 deaths (2646 males and 779 females). Data came from the WHO Mortality Database (1969–1986) and the Scientific Institute of Public Health (1987–2009). Data for 1985 and 2000–2002 were missing and were estimated by linear interpolation. The geographic analysis covered all 43 Belgian districts for 2005–2009.
• Exposure: No individual exposure data. Mesothelioma was identified by ICD code: ICD-10 C45 from 1998, and before that the pleural cancer codes ICD-8 163.0 and ICD-9 163. District mortality was compared with the locations of 24 known asbestos companies in 17 districts. Of these, 9 were asbestos–cement manufacturers. The others included shipyards and makers of automobile parts, electrical material, aluminum foil, textile and paper. The authors state that information about asbestos exposure in specific companies was not available. Fiber types are not specified.
• Main results:
  • For 1994–2008, Belgium's age-adjusted mesothelioma mortality rate (world standard population) was 9.6 per million, based on 1467 deaths over eight reporting years. This was the fourth highest among the countries compared, behind the United Kingdom (17.8), Australia (16.5) and Italy (10.3).
  • For 1994–2008, Belgian age-adjusted rates were 18.0 deaths per million for males and 3.1 deaths per million for females.
  • Between 1994 and 2008, Belgian male mesothelioma deaths were 4.7 times higher than female deaths. Only the United Kingdom (5.7 to 1) and Australia (5.4 to 1) had higher male-to-female ratios.
  • Between 1994 and 2008, Belgian male mortality rates increased 3.23% per year. There was no significant change in rates among Belgian women.
  • From 1969 to 2009, the male age-adjusted rate (European standard population) increased from 2.5 to 26.3 deaths per million, with a sharp increase apparent in 1984.
  • Over the same period, the female rate increased from 1.6 deaths per million in 1969 to 4.1 deaths per million in 2009.
  • The male-to-female ratio rose from 2.1 in 1983 to 6.4 in 2009.
  • From 1969 to 2009, rates rose 6.65% per year for males and 3.04% per year for females. Since 1983, they rose 5.44% per year for males and 2.80% per year for females. The authors report these rises as significant for both sexes at the 0.01 level.
  • For males in 2005–2009, five adjacent districts had a significant excess of mesothelioma deaths: Sint-Niklaas (SMR 3.4, CI 2.7–4.4), Mechelen (SMR 2.5, CI 2.0–3.2), Dendermonde (SMR 1.8, CI 1.2–2.5), Halle-Vilvoorde (SMR 1.4, CI 1.1–1.8) and Antwerp (SMR 1.3, CI 1.1–1.6). Large asbestos industries, including asbestos–cement manufacturers and shipbuilding, were located in these districts.
  • For females in 2005–2009, 10 districts had no mesothelioma deaths, and districts with asbestos textile industries had low ratios. Only Mechelen (SMR 2.8, CI 1.6–4.6) and Halle-Vilvoorde (SMR 2.5, CI 1.6–3.7) had higher than expected female death rates.
• The authors' conclusion: The authors concluded that asbestos mortality in Belgium has been underestimated for decades and that Belgium has one of the highest mesothelioma mortality rates in the world. In their view, the location of asbestos industries is correlated with mesothelioma rates. They called for screening of potentially contaminated sites and for a global ban on asbestos.
• Limitations the authors state:
  • Belgian data (1994–1999 and 2003–2008) were compared with international data from heterogeneous periods, so average rates may be influenced by differences in reported years.
  • Under-reporting of mesothelioma deaths is a concern, and caution is needed when comparing countries.
  • Using several ICD revisions may have caused some misclassification. The pre-1998 codes, which record pleural cancer, capture only pleural mesothelioma.
  • Deaths were assigned to the district of residence at death. Commuting, and changes of residence during the long latency period, may affect the geographic pattern. Migration, work history and exposure abroad were not included.
  • Only large, documented asbestos production facilities were identified, so many sources of occupational exposure could not be pinpointed.
  • Data were missing for 1985 and 2000–2002 and were estimated by linear interpolation. The authors note that the 1985 interpolation may mask a more fluctuating transition.

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: Mesothelioma, Asbestos Exposure.

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• Treatment patterns and survival analysis in 9014 patients with malignant pleural mesothelioma from Belgium, the Netherlands and England — R.A. Damhuis, A. Khakwani, et al. (2015)
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• Belgium: historical champion in asbestos consumption — T.S. Nawrot, G. Van Kersschaever, et al. (2007)
• Assessing the completeness and correctness of the registration of malignant mesothelioma in Belgium — M. Rosskamp, H. De Schutter, et al. (2018)

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