Asbestos: use, bans and disease burden in Europe

Our plain-English summary of Asbestos: use, bans and disease burden in Europe, by T. Kameda, K. Takahashi, R. Kim, et al (Bulletin of the World Health Organization, 2014).

The study

• Authors: T. Kameda, K. Takahashi, R. Kim, Y. Jiang, M. Movahed, E.K. Park, J. Rantanen
• Journal: Bulletin of the World Health Organization
• Published: 2014;92(11):790-7
• Cited by: 77 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Objective: To analyse national data on asbestos use and related diseases in the European Region of the World Health Organization (WHO).

Methods: For each of the 53 countries, per capita asbestos use (kg/capita/year) and age-adjusted mortality rates (deaths/million persons/year) due to mesothelioma and asbestosis were calculated using the databases of the United States Geological Survey and WHO, respectively. Countries were further categorized by ban status: early-ban (ban adopted by 2000, n = 17), late-ban (ban adopted 2001-2013, n = 17), and no-ban (n = 19).

Findings: Between 1920-2012, the highest per capita asbestos use was found in the no-ban group. After 2000, early-ban and late-ban groups reduced their asbestos use levels to less than or equal to 0.1 kg/capita/year, respectively, while the no-ban group maintained a very high use at 2.2 kg/capita/year. Between 1994 and 2010, the European Region registered 106,180 deaths from mesothelioma and asbestosis, accounting for 60% of such deaths worldwide. In the early-ban and late-ban groups, 16/17 and 15/17 countries, respectively, reported mesothelioma data to WHO, while only 6/19 countries in the no-ban group reported such data. The age-adjusted mortality rates for mesothelioma for the early-ban, late-ban and no-ban groups were 9.4, 3.7 and 3.2 deaths/million persons/year, respectively. Asbestosis rates for the groups were 0.8, 0.9 and 1.5 deaths/million persons/year, respectively.

Conclusion: Within the European Region, the early-ban countries reported most of the current asbestos-related deaths. However, this might shift to the no-ban countries, since the disease burden will likely increase in these countries due the heavy use of asbestos.

In plain English

This descriptive analysis covered the 53 countries of the World Health Organization (WHO) European Region. The authors calculated raw asbestos use per person for 1920 to 2012 and age-adjusted death rates from mesothelioma and asbestosis for 1994 to 2010. They grouped countries as early-ban (ban adopted by 2000, 17 countries), late-ban (2001 to 2013, 17) or no-ban (19). From 2001 to 2012, the early-ban and late-ban groups used 0.1 kg per person per year or less, while the no-ban group used 2.2 kg. Including other data sources, Europe registered 106 180 deaths from these diseases, 60% of the reported global total. Mesothelioma deaths were reported by 16 of 17 early-ban, 15 of 17 late-ban and 6 of 19 no-ban countries. Among reporting countries, mesothelioma death rates were 9.4, 3.7 and 3.2 per million people per year, and asbestosis rates were 0.8, 0.9 and 1.5, in the early-ban, late-ban and no-ban groups respectively. The authors said the no-ban group's lower recorded mortality, based on sparse data, likely reflects underdiagnosis and underreporting. They speculated that the future burden will likely shift towards no-ban countries.

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 data on asbestos use and deaths from mesothelioma and asbestosis, by national asbestos ban status
• Who was studied: The 53 countries of the WHO European Region. Asbestos use covered 1920 to 2012. Deaths from mesothelioma and asbestosis in the WHO mortality database covered 1994 to 2010. Countries were grouped as early-ban (ban adopted by 2000, n = 17), late-ban (2001 to 2013, n = 17) and no-ban (n = 19).
• Exposure: National use of raw asbestos per person (kg per person per year), defined as production plus import minus export, from United States Geological Survey data. Fiber types were not distinguished.
• Main results:
  • From 2001 to 2012, the early-ban and late-ban groups reduced average use to 0.1 kg per person per year or less, while the no-ban group continued to use an average of 2.2 kg per person per year.
  • The no-ban group had very high and high levels of asbestos use throughout the study period. Its per person use was 1.8 kg per year (1920 to 1970) and 8.0 kg per year (1971 to 2000). Over the same periods, use was 1.2 and 1.6 kg in the early-ban group and 0.5 and 1.2 kg in the late-ban group (Table 2).
  • Europe recorded 71 686 mesothelioma deaths (56% of the global figure) and 5732 asbestosis deaths (41%) in the WHO mortality database. Another 28 762 deaths were associated with mesothelioma from other sources. The total was 106 180 asbestos-related disease deaths, 60% of the reported global burden.
  • Europe's age-adjusted mortality rates were higher than the world average: 7.8 versus 5.2 deaths per million persons per year for mesothelioma, and 1.0 versus 0.8 for asbestosis.
  • Mesothelioma deaths were reported to WHO by 16/17 (94%) early-ban, 15/17 (88%) late-ban and 6/19 (32%) no-ban countries. Of the 71 686 mesothelioma deaths, 64 156 (89%) were in the early-ban group, 7407 (10%) in the late-ban group and 123 (less than 1%) in the no-ban group.
  • Among reporting countries, age-adjusted mesothelioma mortality rates (crude rates in brackets) were 9.4 (16.5) in the early-ban group, 3.7 (4.7) in the late-ban group and 3.2 (0.6) in the no-ban group, in deaths per million persons per year.
  • Asbestosis deaths were reported by 16/17 early-ban, 13/17 late-ban and 4/19 no-ban countries. These accounted for 5385, 339 and 8 deaths respectively. Age-adjusted asbestosis mortality rates (crude rates in brackets) were 0.8 (1.4), 0.9 (0.3) and 1.5 (0.2) deaths per million persons per year.
• The authors' conclusion: The authors speculated that the future burden of asbestos-related diseases will likely shift from the early-ban and late-ban countries towards the no-ban countries, where recent asbestos use has been concentrated.
• Limitations the authors state:
  • Asbestos use data were extrapolated for several countries that lacked specific data because of political transitions.
  • Data on the use of imported asbestos-containing products were not available.
  • Asbestos-related diseases are rare and difficult to diagnose, so countries with limited experience of these diseases could have introduced serious bias.
  • The lower mortality recorded in the no-ban group rests on sparse data, and the authors judged it likely reflects underdiagnosis and underreporting.

Topics

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

Medical terms in this study, explained in our Lexicon: Mesothelioma.

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