Burden of malignant mesothelioma in China during 1990-2019 and the projections through 2029

Our plain-English summary of Burden of malignant mesothelioma in China during 1990-2019 and the projections through 2029, by Q. Huang, Y. Chen, L. Lian, et al (Journal of the National Cancer Center, 2024).

The study

• Authors: Q. Huang, Y. Chen, L. Lian, Q. Lei, J. Chen, L. Wu, K. Hemminki, J. Ji, T. Chen
• Journal: Journal of the National Cancer Center
• Published: 2024;4(3):214-222
• Cited by: 13 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Objective: To provide the most up-to-date data on the burden of malignant mesothelioma (MM) and the projections through 2029 in China.

Methods: Data on patients diagnosed with MM from China during 1990-2019 were obtained from the Global Burden of Disease (GBD) 2019 database, including annual cases and deaths data and age-standardized rates of incidence, mortality, and disability-adjusted life-years (DALYs) associated with MM among different age groups. Temporal trends during 1990-2019 were analyzed by the Joinpoint regression models using 95% confidence interval (CI), while the projections through 2029 were calculated by the Bayesian age-period-cohort model. Data on the production and consumption of asbestos in China were obtained from the United States Geological Survey on Mineral Commodity Summaries during 1996-2023.

Results: We observed a significant elevation in incident new cases and deaths over the last 3 decades, increasing from 1193 in 1990 to 2815 in 2019 for incident cases and from 1134 in 1990 to 2773 in 2019 for death cases. We found a roughly 6% increase in the proportion of incident cases for those aged >70 years (30% in 2019 versus 24% in 1990), while for the proportion of deaths similar elevation for those aged >70 years was found. Additionally, men had significantly higher DALYs due to MM across age groups compared with women. Asbestos consumption in China dramatically dropped since 2012 and reached the bottom in 2017 with 230 kilotons. By 2029, the projected age-standardized rate for incidence and mortality is expected to reach 1.2 per million for both.

Conclusion: We found, for the first time using GBD data on the Chinese population, that the burden of MM has been significantly increasing in China over the last three decades and will continue to increase in the upcoming decade, suggesting an urgent need for a complete ban on chrysotile asbestos in China.

© 2024 Chinese National Cancer Center. Published by Elsevier B.V.

In plain English

This study used Global Burden of Disease (GBD) 2019 estimates of malignant mesothelioma in China for 1990 to 2019. It projected them to 2029 and compared them with United States Geological Survey asbestos production and consumption figures. Estimated new cases rose from 1193 in 1990 to 2815 in 2019, and deaths from 1134 to 2773. The share of new cases in people over 70 rose from 24% to 30%. The overall age-standardized incidence rate went from 1.3 per million (95% uncertainty interval 1.0–1.9) to 1.4 per million (1.2–1.7), not a statistically significant change. Age-standardized rates rose in men and fell in women. Asbestos consumption peaked at 660 kilotons in 2008 and fell to 230 kilotons in 2017. The models projected 3101 new cases (95% uncertainty interval 2766–3436) and 3149 deaths (2804–3494) in 2029, while age-standardized rates were projected to decline. The authors concluded that the burden had been increasing and would keep increasing, suggesting an urgent need for a complete ban on chrysotile asbestos in China. They noted that the GBD data did not separate pleural from peritoneal mesothelioma.

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 Global Burden of Disease 2019 estimates, with joinpoint regression for 1990–2019 trends and Bayesian age-period-cohort models for projections to 2029
• Who was studied: GBD 2019 estimates of malignant mesothelioma (ICD-10 codes C45–C45.9) for China, 1990–2019, drawn from 243 datasets
• Exposure: National asbestos production and consumption in China, 1995–2022, from the United States Geological Survey. The study also used GBD estimates of the proportion of mesothelioma deaths attributable to occupational asbestos exposure. Fiber type was not measured in the analysis.
• Main results:
  • Estimated mesothelioma incident cases in China rose from 1193 in 1990 to 2815 in 2019, and deaths rose from 1134 to 2773
  • The share of incident cases in people aged over 70 rose from 24% (1990) to 30% (2019). The share in people aged under 50 fell from 31% to 21%.
  • For both sexes combined, the age-standardized incidence rate showed no statistically significant change: 1.3 per million (95% UI 1.0–1.9) in 1990 and 1.4 per million (95% UI 1.2–1.7) in 2019. The age-standardized mortality and DALY rates also showed no significant change.
  • In men, age-standardized incidence rose from 1.2 to 1.8 per million, mortality from 1.3 to 1.8 per million, and DALYs from 34.9 to 50.9 per million. In women, all age-standardized rates showed downward trends.
  • In the joinpoint analysis, age-standardized rates increased marginally overall and in men (P less than 0.05). There was a significant downward trend in women.
  • The proportion of mesothelioma deaths attributable to occupational asbestos exposure was lower in men than in women at the start of the period, and surpassed that in women in 2009
  • Asbestos consumption in China peaked at 660 kilotons in 2008, dropped to 430 kilotons in 2012 and to 230 kilotons in 2017. Production peaked at 440 kilotons in 2012 and was 200 kilotons in 2017.
  • Projected for 2029 (both sexes): 3101 incident cases (95% UI 2766 to 3436), an 11% increase, and 3149 deaths (95% UI 2804 to 3494), a 14% increase
  • Age-standardized incidence and mortality rates were projected to reach 1.2 per million each by 2029, a declining trend in rates over the decade
• The authors' conclusion: The authors concluded that the mesothelioma burden in China had been increasing over three decades and would continue to increase in the coming decade. They said this suggested an urgent need for a complete ban on chrysotile asbestos in China.
• Limitations the authors state:
  • GBD data come from different locations, which may introduce bias from uneven regional development and lead to underestimation of the burden
  • The GBD database did not give genetic factors or mesothelioma subtypes (pleural vs peritoneal)
  • The impact of the COVID-19 pandemic was not considered
  • The true numbers of cases and deaths might exceed the estimates

Topics

Medical terms in this study, explained in our Lexicon: Malignant Mesothelioma, confidence interval, Chrysotile.

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