Burden and trends of cancer attributable to occupational asbestos exposure in China from 1990 to 2021

Our plain-English summary of Burden and trends of cancer attributable to occupational asbestos exposure in China from 1990 to 2021, by B. Chen, X. Zheng, H. Zheng, et al (Frontiers in Public Health, 2025).

The study

• Authors: B. Chen, X. Zheng, H. Zheng, H. Chen, S. Xu, Q. Li, H. Lin, J. Yu, Y. Xu, Z. Guo, Z. Zhan
• Journal: Frontiers in Public Health
• Published: 2025;13:1672598
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Occupational exposure to asbestos remains a major public health concern in China, particularly due to the long latency of asbestos-related diseases and the persistent use of asbestos in male-dominated industries. However, the long-term trends and drivers of asbestos-related cancer burden have not been fully quantified.

Methods: This study used data from the Global Burden of Disease Study 2021 to estimate the burden of total cancer attributable to occupational asbestos exposure in China from 1990 to 2021. Key indicators included deaths, disability-adjusted life years (DALYs), years lived with disability (YLDs), and years of life lost (YLLs), disaggregated by age, sex, cancer type, and time period. Joinpoint regression and age-period-cohort analyses were conducted to explore temporal dynamics, while decomposition analysis assessed the contributions of population growth, aging, and epidemiological changes.

Results: In 2021, occupational asbestos exposure led to 29,020 deaths and 535,732 DALYs in China, with a significantly higher burden among males. The number of cases rose steadily from 1990, with sharp increases between 2000 and 2010, plateauing thereafter and rising again after 2017. Age-standardized rates showed dynamic trends: increasing until 2010-2011, declining until 2018, and rebounding modestly, particularly among females. The burden was highest among individuals aged 85-94 and showed a rightward shift over time. Lung cancer accounted for over 85% of asbestos-related DALYs, followed by mesothelioma, ovarian, and laryngeal cancers. Joinpoint and age-period-cohort analyses highlighted long-latency effects and generational shifts, while decomposition showed that aging and epidemiological changes were the dominant drivers of increased deaths, whereas DALYs were primarily driven by epidemiological factors and population growth.

Conclusion: The burden of asbestos-related cancers in China remains substantial and is rising due to demographic aging and persistent exposure risks. Stronger occupational safety regulations, exposure surveillance, and asbestos bans are urgently needed to curb future disease burden.

Copyright © 2026 Chen, Zheng, Zheng, Chen, Xu, Li, Lin, Yu, Xu, Guo and Zhan.

In plain English

This study analyzed Global Burden of Disease Study 2021 estimates for China, 1990 to 2021. The figures are modeled: exposure was estimated indirectly from mesothelioma deaths using the Asbestos Impact Ratio. For 2021, the estimates attributed 29,020 cancer deaths (95% uncertainty interval 18,442 to 42,779) and 535,732 disability-adjusted life years (346,751 to 802,494) to occupational asbestos exposure. Deaths numbered 21,329 (12,696 to 33,520) in males and 7,691 (4,203 to 12,250) in females. Age-standardized death rates per 100,000 were 2.67 (1.59 to 4.15) in males and 0.71 (0.39 to 1.13) in females. Cancers of the trachea, bronchus and lung made up 89.7 percent of deaths, followed by mesothelioma, ovarian and laryngeal cancer. Age-standardized rates rose from 1998 to 2011, fell until 2018, then leveled off or rose slightly, most notably in females. Rates were highest at ages 85 to 94. Those born after 1940 had lower rates at the same ages than earlier generations. Population aging contributed most to the rise in deaths. The authors concluded that the burden remains substantial and is rising. Smoking and silica dust were not accounted for.

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 modeled Global Burden of Disease (GBD) 2021 estimates, with joinpoint regression, age-period-cohort and decomposition analyses
• Who was studied: Population of China, 1990 to 2021, using GBD estimates by sex and five-year age group
• Exposure: Occupational asbestos exposure, with no fiber type specified. In the GBD it is modeled with the Asbestos Impact Ratio, which is based on excess mesothelioma deaths, used as a proxy for population-level exposure.
• Main results:
  • In 2021, an estimated 29,020 cancer deaths (95% uncertainty interval 18,442 to 42,779) in China were attributable to occupational asbestos exposure, most of them in males
  • Attributable deaths in 2021 were 21,329 in males (95% uncertainty interval 12,696 to 33,520) and 7,691 in females (4,203 to 12,250)
  • Age-standardized death rate in 2021: 1.51 per 100,000 overall (0.96 to 2.21), 2.67 in males (1.59 to 4.15) and 0.71 in females (0.39 to 1.13)
  • In 2021 there were 535,732 attributable DALYs (95% uncertainty interval 346,751 to 802,494). The age-standardized DALY rate was 25.88 per 100,000 overall, 42.74 in males and 12.73 in females.
  • Cancers of the trachea, bronchus and lung accounted for 89.7% of attributable deaths and 86.0% of DALYs in 2021, followed by mesothelioma, ovarian cancer and laryngeal cancer
  • In 2021, age-specific rates of deaths, DALYs and YLLs were highest among people aged 85 to 94
  • Joinpoint regression found a steep rise in age-standardized rates from 1998 to 2011, with annual percent changes above 3% for all indicators in both sexes. All indicators then declined significantly from 2011 to 2018.
  • From 2018 onward, females showed renewed rises in age-standardized DALY rates (average annual percent change 1.07, 95% CI 0.50 to 1.87) and YLD rates (1.72, 95% CI 1.18 to 2.54)
  • In the age-period-cohort analysis, people born after 1940 had progressively lower DALY and death rates at comparable ages, while those born between 1900 and 1935 had markedly higher rates
  • Decomposition of the 1990 to 2021 change: for deaths, population aging was the largest contributor, followed by epidemiologic change, with population growth smaller
  • For DALYs, epidemiologic change was the dominant driver, followed by population growth, while aging had a mitigating effect
• The authors' conclusion: The authors concluded that the burden of asbestos-related cancers in China remains substantial and is rising, which they attributed to demographic aging and persistent exposure risks
• Limitations the authors state:
  • Estimates rely on modeled data rather than individual-level exposure
  • The Asbestos Impact Ratio may not capture China's varied exposure, such as regional differences and informal sectors, which could lead to under- or overestimation in some subpopulations
  • Because of long latency, current estimates may understate future incidence among people exposed in recent decades
  • Misclassification of mesothelioma and other asbestos-related cancers may affect accuracy, and no misclassification-specific sensitivity analyses were done
  • The analysis did not account for co-exposures such as silica dust or smoking
  • There were no nationally representative data on fiber mineralogy, asbestos use by sector and province, or occupation-specific exposure
  • The authors said the recent rise among females should be interpreted cautiously and may partly reflect improved case detection

Topics

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

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• Burden of laryngeal cancer attributable to occupational asbestos exposure in China: A comprehensive analysis from 1990 to 2021 — B. Chen, Z. Zhan, et al. (2025)
• Trends in the disease burden of early-onset cancers in China from 1990 to 2021: a systematic analysis of the 2021 Global Burden of Disease study — J. Zhu, T. Li, et al. (2025)
• A comparative study of the disease burden attributable to asbestos in Brazil, China, Kazakhstan, and Russia between 1990 and 2019 — J. Chen, C. Wang, et al. (2022)
• Global Burden, Projection, and Inequalities Analysis of Cancer Attributable to Occupational Carcinogen Exposure in Individuals Aged Over 40 Years — N. Hu, H. Li, et al. (2025)
• The global burden of cancers attributable to occupational factors, 1990-2021 — B. Zou, P. Wu, et al. (2025)
• Burden of Lung Cancer Attributable to Occupational Carcinogens from 1990 to 2019 and Projections until 2044 in China — Y. Fan, Y. Jiang, et al. (2022)

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