Assessing trends and burden of occupational exposure to asbestos in the United States: a comprehensive analysis from 1990 to 2019

Our plain-English summary of Assessing trends and burden of occupational exposure to asbestos in the United States: a comprehensive analysis from 1990 to 2019, by X. Li, X. Su, L. Wei, et al (BMC Public Health, 2024).

The study

• Authors: X. Li, X. Su, L. Wei, J. Zhang, D. Shi, Z. Wang
• Journal: BMC Public Health
• Published: 2024;24(1):1404
• Cited by: 7 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: This study aimed to analyze the trends and burden of occupational exposure to asbestos in the United States (U.S.) from 1990 to 2019, focusing on mortality rates, geographic distribution, age and sex patterns, and causes of death.

Methods: Data on the number of deaths attributable to occupational exposure to asbestos were collected from 1990 to 2019 in the U.S. Joinpoint analysis was conducted to assess trends over time, and regression models were applied to calculate annual percentage changes (APC) and annual average percentage changes (AAPC). Geographic distribution was examined using mapping techniques. Age and sex patterns were analyzed, and causes of death were identified based on available data.

Results: From 1990 to 2019, the overall number of deaths due to occupational exposure to asbestos in the U.S. increased by 20.2%. However, age-standardized mortality rates (ASMR) and age-standardized disability-adjusted life years (DALYs) rates (ASDR) exhibited a decline over the same period. Geographic analysis revealed differences in the number of deaths across states in 2019, with California reporting the highest number of fatalities. Age-specific mortality and DALYs showed an increase with age, peaking in older age groups. Tracheal, bronchus, and lung cancer were the leading causes of death attributed to asbestos exposure, with increasing trends observed over the past five years.

Conclusion: The study highlights significant trends and burden in occupational exposure to asbestos in the U.S., including overall increases in mortality rates, declining ASMR and ASDR, geographic disparities, age and sex patterns, and shifts in causes of death. These findings underscore the importance of continued monitoring and preventive measures to mitigate the burden of asbestos-related diseases.

© 2024. The Author(s).

In plain English

This study analyzed Global Burden of Disease 2019 estimates of U.S. deaths and disability-adjusted life years (DALYs) from occupational asbestos exposure, 1990 to 2019. Estimated deaths rose from 33,926.7 (95% uncertainty interval 24,871.5 to 42,661.4) in 1990 to 40,764.1 (30,522.8 to 51,859.3) in 2019, a 20.2% increase. Age-standardized death and DALY rates fell, averaging -1.3% (95% CI -1.5 to -1) and -1.8% (-2 to -1.6) per year. The male age-standardized death rate fell from 21.94 (15.63 to 28.17) to 13.21 (9.39 to 17.14) per 100,000. The female rate rose from 1.9 (1.28 to 2.57) to 2.02 (1.29 to 2.9), with a non-significant average annual change of 0.2% (95% CI 0 to 0.5). Tracheal, bronchus and lung cancer caused the most estimated deaths: 35,642.8 (25,661.7 to 46,332.5) in 2019. Mesothelioma ranked second in both sexes and males, ovarian cancer in females. In 2019 California had the most deaths; West Virginia, Maine and Louisiana had the highest age-standardized death and DALY rates. The authors concluded that overall rates fell while death numbers rose; they noted the model-based figures may be biased.

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: Secondary analysis of model-based Global Burden of Disease (GBD) 2019 estimates, using joinpoint regression to describe trends over time (annual percentage change, APC, and average annual percentage change, AAPC)
• Who was studied: The population of the United States, 1990 to 2019, broken down by sex, age group and state (state figures for 2019 only)
• Exposure: Occupational exposure to asbestos as defined in the GBD. The analysis does not specify fiber types. Outcomes counted were tracheal, bronchus and lung cancer, mesothelioma, pneumoconiosis, larynx cancer and ovarian cancer.
• Main results:
  • Both sexes: estimated deaths attributable to occupational asbestos exposure rose from 33,926.7 (95% UI 24,871.5 to 42,661.4) in 1990 to 40,764.1 (95% UI 30,522.8 to 51,859.3) in 2019, a 20.2% increase
  • Both sexes, 1990 to 2019: the age-standardized mortality rate had an AAPC of -1.3 (95% CI -1.5 to -1), and the age-standardized DALY rate had an AAPC of -1.8 (95% CI -2 to -1.6)
  • Males: the age-standardized mortality rate fell from 21.94 (95% UI 15.63 to 28.17) per 100,000 in 1990 to 13.21 (95% UI 9.39 to 17.14) in 2019, a 39.8% decrease, with an AAPC of -1.7 (95% CI -1.9 to -1.5)
  • Females: the age-standardized mortality rate rose from 1.9 (95% UI 1.28 to 2.57) in 1990 to 2.02 (95% UI 1.29 to 2.9) in 2019, a 6.3% increase. The AAPC was 0.2 (95% CI 0 to 0.5). Table 2 gives a P value of 0.094, which is above the study's threshold for statistical significance of P less than 0.05.
  • Both sexes, 2016 to 2019: the age-standardized DALY rate had an APC of 1.6 (0.2 to 3, P = 0.024), and the age-standardized mortality rate had an APC of 0.8 (-0.6 to 2.3, P = 0.264). The authors note that only the DALY rate increase was statistically significant.
  • Both sexes: estimated tracheal, bronchus and lung cancer deaths rose from 30,463.8 (95% UI 21,523.4 to 39,006.8) in 1990 to 35,642.8 (95% UI 25,661.7 to 46,332.5) in 2019, a 17% increase. This was the leading cause of death attributed to occupational asbestos exposure.
  • Mesothelioma was the second leading cause of death in both sexes and in males; ovarian cancer was second in females. Table 1 gives mesothelioma deaths in both sexes as 2,118.7 in 1990 and 3,091.8 in 2019, a 45.9% increase.
  • Both sexes: pneumoconiosis deaths rose from 316.9 (95% UI 287.3 to 434.4) in 1990 to 690.6 (95% UI 564.8 to 753.1) in 2019, a 117.9% increase
  • In 2019, California had the highest number of deaths (3,151) among U.S. states
  • In 2019, West Virginia, Maine and Louisiana had the highest age-standardized mortality rates, at 12.4, 11.3 and 10.5 per 100,000 respectively
  • In 2019, West Virginia, Maine and Louisiana also had the highest age-standardized DALY rates, at 218.3, 186.5 and 182 per 100,000
  • Deaths and DALYs were lower in females than in males from 1990 to 2019. In 2019, the number of deaths peaked at ages 75 to 79 in males and 80 to 84 in females.
• The authors' conclusion: The authors concluded that death rates from occupational asbestos exposure in the U.S. have been falling, while the number of deaths has kept rising, especially from tracheal, bronchus and lung cancers
• Limitations the authors state:
  • GBD data are reconstructed by mathematical models from data sources of differing quality, so bias is hard to avoid
  • The joinpoint regression model used for the trends has its own limitations
  • The study did not assess non-occupational asbestos exposure
  • The GBD has no precise data; the figures are model inferences that still need to be confirmed
  • Differences in the early identification of diseases may introduce bias
  • The GBD did not account for the impact of pneumoconiosis on asbestosis data, which may overestimate the asbestosis burden

Topics

Medical terms in this study, explained in our Lexicon: Occupational Exposure, Bronchus, Lung Cancer, Asbestos Exposure.

Related studies

• Mesothelioma trends in the United States: an update based on Surveillance, Epidemiology, and End Results Program data for 1973 through 2003 — B. Price, A. Ware (2004)
• Time trend of mesothelioma incidence in the United States and projection of future cases: an update based on SEER data for 1973 through 2005 — B. Price, A. Ware (2009)
• Recent trends in mesothelioma incidence in the United States — R. Spirtas, G.W. Beebe, et al. (1986)
• Re: "Mesothelioma trends in the United States: an update based on surveillance, epidemiology, and end results program data for 1973 through 2003" — J.H. Lange (2004)
• Response to Letter to the Editor Regarding "Ambient Asbestos Fiber Concentrations and Long-Term Trends in Pleural Mesothelioma Incidence Between Urban and Rural Areas in the United States (1973-2012)" by Finkelstein — K.A. Keeton, M.E. Glynn, et al. (2018)
• Letter Concerning: Glynn ME, Keeton KA, Gaffney SH, Sahmel J. Ambient Asbestos Fiber Concentrations and Long-Term Trends in Pleural Mesothelioma Incidence Between Urban and Rural Areas in the United States (1973-2012). Risk Analysis 2018;38(3):454-471 — M.M. Finkelstein (2018)

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