Asbestos use and asbestos-related diseases in Asia: past, present and future

Our plain-English summary of Asbestos use and asbestos-related diseases in Asia: past, present and future, by G.V. le, K. Takahashi, E.K. Park, et al (Respirology, 2011).

The study

• Authors: G.V. le, K. Takahashi, E.K. Park, V. Delgermaa, C. Oak, A.M. Qureshi, S.M. Aljunid
• Journal: Respirology
• Published: 2011;16(5):767-75
• Cited by: 65 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Background And Objective: Although there are growing concerns about the global epidemic of asbestos-related diseases (ARD), the current status of asbestos use and ARD in Asia is elusive. We conducted a descriptive analysis of available data on asbestos use and ARD to characterize the current situation in Asia.

Methods: We used descriptive indicators of per capita asbestos use (kilograms per capita per year) and age-adjusted mortality rates (AAMR, persons per million population per year) by country and for the region, with reference to the world.

Results: The proportion of global asbestos use attributed to Asia has been steadily increasing over the years from 14% (1920-1970) to 33% (1971-2000) to 64% (2001-2007). This increase has been reflected in the absolute level of per capita use across a wide range of countries. In contrast, 12 882 ARD deaths have been recorded cumulatively in Asia, which is equivalent to only 13% of the cumulative number of ARD deaths in the world during the same period. The highest AAMR were recorded in Cyprus (4.8), Israel (3.7) and Japan (3.3), all of which have banned asbestos use.

Conclusions: There is a paucity of information concerning the current situation of ARD in Asia. The marked increase in asbestos use in Asia since 1970, however, is likely to trigger a surge of ARD in the immediate decades ahead.

© 2011 The Authors; Respirology © 2011 Asian Pacific Society of Respirology.

In plain English

This descriptive analysis of national statistics compared 47 Asian countries with 185 worldwide. Asbestos use figures (production plus imports minus exports, 1920–2007) came from the United States Geological Survey. Death data for 1994–2008 came from World Health Organization records of mesothelioma, asbestosis and (under an older code) malignant neoplasm of the pleura, plus published national mesothelioma figures. Asia's share of world asbestos use rose from 14% (1920–1970) to 33% (1971–2000) to 64% (2001–2007); 28 of 47 countries increased use. Asia recorded 12,882 asbestos-related disease deaths, 12.5% of those recorded worldwide; 12,012 fell under the mesothelioma code ICD-10 C45, 13.0% of such deaths worldwide. Among countries with 3 or more years of data, age-adjusted mesothelioma death rates (per million people per year) were highest in Cyprus (4.8), Israel (3.7) and Japan (3.3). Thailand, China and India lacked national mesothelioma data. Thirteen Asian countries (28%) had banned asbestos. The authors concluded that a surge of asbestos-related disease in Asia should be anticipated in coming decades. They said underreporting was probably the main problem, so their figures likely understate reality.

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-level data on asbestos use and asbestos-related disease deaths (no individual patients studied)
• Who was studied: 47 Asian countries (United Nations definition), compared with 185 countries worldwide. Asbestos use data covered 1920–2007; death data covered 1994–2008.
• Exposure: National asbestos use as defined by the United States Geological Survey (production plus import minus export), expressed per person in kg per year. Fiber types were not specified.
• Main results:
  • Asia's share of world asbestos use was 14% in 1920–1970, 33% in 1971–2000 and 64% in 2001–2007
  • Over the whole period 1920–2007, Asia accounted for 29% of world asbestos use
  • 28 of 47 Asian countries (60%) increased asbestos use during the observation period
  • Annual mean asbestos use was 0.1, 0.9 and 1.2 million tons in group A (30 countries with asbestos-use data only) for the three periods. In group B (15 countries with both use and death data) it was 0.08, 0.4 and 0.1 million tons.
  • Kazakhstan was the only country with high per capita use (over 1.0 kg per person per year) in all three periods
  • Deaths recorded as malignant neoplasm of the pleura (an older ICD-9 code) were counted as generally synonymous with pleural mesothelioma
  • The death counts came from WHO records for mesothelioma, malignancy of the pleura and asbestosis, plus mesothelioma figures for one country taken from the scientific literature rather than WHO records
  • Asia recorded 12 882 asbestos-related disease deaths in 1994–2008, 12.5% of such deaths recorded worldwide. Of these, 12 012 were mesothelioma deaths recorded under code ICD-10 C45, 13.0% of deaths recorded under that code worldwide.
  • 17 countries reported mesothelioma deaths and 7 reported asbestosis deaths for at least one year
  • Among countries with at least 3 years of data, age-adjusted mesothelioma death rates (cases per million population per year) were highest in Cyprus (4.8), Israel (3.7) and Japan (3.3)
  • Thailand, China and India had no national mesothelioma data
  • 13 Asian countries (28%) had adopted asbestos bans, compared with 30% of countries worldwide
  • 3 Asian countries (6%) had ratified the ILO Asbestos Convention, compared with 17% of countries worldwide
• The authors' conclusion: The authors concluded that asbestos use in Asia has increased drastically since 1970 and that a surge of asbestos-related disease in Asia should be anticipated in the coming decades
• Limitations the authors state:
  • Asbestos-related diseases are rare and difficult to diagnose
  • Underreporting was probably the most dominant problem, so the findings likely understate the actual situation
  • US Geological Survey asbestos-use data may be less complete for less-developed countries, especially in earlier years
  • Death rates for Bahrain and Macau were each based on a single case in a single year

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