Assessing the global burden of mesothelioma: trends, socioeconomic influences, and asbestos exposure - a retrospective cohort study

Our plain-English summary of Assessing the global burden of mesothelioma: trends, socioeconomic influences, and asbestos exposure - a retrospective cohort study, by Z. Zhao, J. Li, F. Tan, et al (International Journal of Surgery, 2025).

The study

• Authors: Z. Zhao, J. Li, F. Tan, Q. Xue, S. Gao, J. He
• Journal: International Journal of Surgery
• Published: 2025;111(1):93-103
• Cited by: 12 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Introduction: Mesothelioma is an uncommon type of cancer that has received little attention. This study aims to evaluate the global disease burden, trends of mesothelioma by age, sex, and geographic locations, and its risk factors at the population level.

Methods: The Global Cancer Observatory in 2022 and 2019 Global Burden of Disease were accessed for mesothelioma incidence and its risk factors worldwide. Multivariable linear regression analyses were conducted to explore the associations between mesothelioma incidence and key predictors, including Human Development Index (HDI), Gross Domestic Product (GDP) per capita, and occupational asbestos exposure, adjusting for age and sex across global regions.

Results: This study identified 30 870 global cases of mesothelioma in 2022, with a higher age-standardized incidence rate in males (0.25 per 100 000) compared to females (0.39 per 100 000). Geographical analysis indicated the highest disease burden in Northern Europe, with particular prevalence in more developed regions. The incidence was also significantly associated with a higher HDI, with a β coefficient of 0.133 overall, and GDP per capita, with a β coefficient of 0.101. These socioeconomic factors exhibited stronger associations in the elderly population, especially with HDI ( β =0.512) and GDP ( β =0.389), than in adults. Additionally, occupational exposure to asbestos remained a significant risk factor across all groups, except for the younger adult population, with an overall β of 0.122 for incidence. The temporal trend analysis revealed a general decrease in mesothelioma incidence, particularly in the 15-49 years age group.

Conclusions: The analysis indicates a higher mesothelioma incidence in males and in developed regions, with marked disparities noted particularly in Northern Europe. Significant correlations with socioeconomic indicators - HDI and GDP - and occupational asbestos exposure were identified, particularly affecting the elderly. Despite a decline in global incidence, especially among younger individuals, persistent cases in females highlight the need for continued public health measures addressing both occupational and environmental exposures.

Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.

In plain English

The authors describe this as a retrospective cohort study. It used country-level data from the Global Cancer Observatory for 2022, covering 185 countries, and from the 2019 Global Burden of Disease study. Using regression analysis, the authors examined how a country's mesothelioma incidence related to its Human Development Index (HDI), its GDP per capita and its level of occupational asbestos exposure. The article does not specify any fiber types. The authors counted 30,870 mesothelioma cases worldwide in 2022. The article printed age-standardized rates of 0.25 per 100,000 for males and 0.39 per 100,000 for females, even though it also states that rates were higher in males. Higher HDI, higher GDP and occupational asbestos exposure were each associated with higher incidence. These associations were strongest in the elderly group. Asbestos exposure showed no statistically significant association in the adult subgroup. The authors suggested that the socioeconomic links may partly reflect differences in diagnosis and reporting. They reported a decline in incidence, especially at ages 15 to 49, but gave no figures for it. They noted possible underreporting in lower-HDI regions.

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: Labelled by the authors a retrospective cohort study. In practice it is an analysis of country-level data from public cancer databases, using maps and multivariable linear regression adjusted for age and sex.
• Who was studied: Mesothelioma incidence data for 2022 from the Global Cancer Observatory, covering 185 countries, combined with 2019 Global Burden of Disease data. Analyses were split by sex, by age group (all ages 0 to 85+, young 15 to 49, old 50 to 85) and by region.
• Exposure: Occupational exposure to asbestos at country level, taken from the 2019 Global Burden of Disease data and analysed 'per unit increase'. The unit is not defined and no fiber types are named. The 2019 Human Development Index and GDP per capita were also analysed.
• Main results:
  • Worldwide, 30,870 mesothelioma cases were counted in 2022.
  • Males: age-standardized rate of 0.25 per 100,000, with 26,278 cases.
  • Females: age-standardized rate of 0.39 per 100,000, described in the article as higher, with 7,597 cases.
  • Northern Europe: age-standardized rate of 0.31 per 100,000 for males and 0.29 per 100,000 for females, described as the highest observed.
  • Australia and New Zealand: 943 cases, with an age-standardized rate printed as 1.2 per 100,000 for males and 'two per 100 000' for females.
  • HDI and incidence, all countries: beta coefficient 0.133 (95% CI 0.107 to 0.159, p less than 0.001). In the elderly group the beta was 0.512, compared with 0.011 in the adult group.
  • GDP per capita and incidence, per $10,000 increase: beta 0.101 (95% CI 0.085 to 0.118, p less than 0.001). In the elderly group the beta was 0.389, compared with 0.011 in the adult group.
  • Occupational asbestos exposure and incidence, overall: beta 0.122 (95% CI 0.106 to 0.137, p less than 0.001) per unit increase.
  • Occupational asbestos exposure in the adult subgroup: no statistically significant association (beta 0.025, p = 0.3).
  • Occupational asbestos exposure in the elderly group: beta 0.195, p less than 0.001.
  • With all three factors in one model, each remained significantly associated with incidence: HDI beta 0.043 (p = 0.002), GDP beta 0.036 (p less than 0.001), asbestos beta 0.085 (p less than 0.001).
  • In the discussion, the authors state that incidence declined overall over the past decade, especially at ages 15 to 49. No trend figures are given in the results.
• The authors' conclusion: The authors concluded that mesothelioma incidence was higher in males and in developed regions, especially Northern Europe. They found it was associated with HDI, GDP and occupational asbestos exposure, particularly in the elderly. They suggested that the socioeconomic associations may partly reflect differences in recognition, diagnosis and reporting.
• Limitations the authors state:
  • Mesothelioma may be underreported in regions with lower HDI, which may lead to underestimating the true burden.
  • Data collection methods vary across regions and countries.
  • The analysis did not include genetic predisposition or lifestyle factors such as smoking.

Topics

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

Medical terms in this study, explained in our Lexicon: Mesothelioma, Asbestos Exposure, Cohort Study, Incidence, Occupational Exposure, Environmental Exposure.

Related studies

• Investigation of the trends and associated factors of ovarian cancer in Indonesia: A systematic analysis of the Global Burden of Disease study 1990-2021 — B.A. Tjokroprawiro, K. Novitasari, et al. (2025)
• Global and regional burden of disease and injury in 2016 arising from occupational exposures: a systematic analysis for the Global Burden of Disease Study 2016 — GBD 2016 Occupational Risk Factors Collaborators (2020)
• Global, regional, and national burden of ovarian cancer among young women during 1990-2019 — Q. Zhuang, G. Gu, et al. (2025)
• The global burden of cancers attributable to occupational factors, 1990-2021 — B. Zou, P. Wu, et al. (2025)
• The global burden and associated factors of ovarian cancer in 1990-2019: findings from the Global Burden of Disease Study 2019 — S. Zhang, C. Cheng, et al. (2022)
• Global burden of tracheal, bronchus, and lung cancer attributable to occupational carcinogens in 204 countries and territories, from 1990 to 2019: results from the global burden of disease study 2019 — Y. Zhang, M. Mi, et al. (2023)

Browse return to medical research.