Estimation of the past and future burden of mortality from mesothelioma in France

Our plain-English summary of Estimation of the past and future burden of mortality from mesothelioma in France, by A.G. Ilg, J. Bignon, A.J. Valleron (Occupational and Environmental Medicine, 1998).

The study

• Authors: A.G. Ilg, J. Bignon, A.J. Valleron
• Journal: Occupational and Environmental Medicine
• Published: 1998;55(11):760-5
• Cited by: 42 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Objectives: Firstly to evaluate future mortality from mesothelioma in France with an age-period-cohort approach and evaluate different hypotheses on risk of mesothelioma for the most recent birth cohort. Secondly to compare the results with a British and an American study. Thirdly to study if any trends were detectable on data for women which would be consistent with the consequences of increasing environmental exposure to asbestos.

Methods: Estimates of mortality from mesothelioma among men and women in France from 1950 to 1995 were based on the analysis of the pleural cancer mortality data coded 163 in the ninth revision of the international classification of diseases (ICD-9). Correction factors were used to derive the mortality from mesothelioma from these data, based on two regional registries. The analysis of the past mortality data has been performed by an age-cohort model (with a maximum likelihood technique). Predictions of deaths from mesothelioma over the next 50 years were based on four different assumptions on the risk of death from mesothelioma in future birth cohorts.

Results: The predicted lifetime probability of dying from mesothelioma increases until the last birth cohort 1964-8 among men whereas it decreases strongly from the 1954-8 birth cohort among women. The projected numbers of deaths from mesothelioma in France until 2020 are similar, whichever hypothesis is considered: around 20,000 deaths from mesothelioma might occur among men and 2900 among women from 1996 to 2020.

Conclusions: French data show an increasing lifetime probability of death from mesothelioma in the more recent male cohorts. Although the mortality burden can be predicted until 2020, and is intermediate between the United Kingdom and United States estimates, there is still high uncertainty on the figures after 2020. No increase is found in women, and this does not support the hypothesis that current environmental exposure to asbestos could be associated with a detectable risk of death. Specific surveillance should be set up to monitor future trends or their absence.

In plain English

This study estimated past and future deaths from mesothelioma in France. Because France had no national mesothelioma register, the authors estimated mesothelioma deaths from death-certificate data on pleural cancer for people aged 25 to 89 from 1950 to 1995, using correction factors from regional studies. They fitted an age-cohort model and projected deaths under four assumptions about risk in future birth cohorts. Age-standardised mortality among men rose from 5.81 to 25.75 per million between 1950 and 1995. Among women it rose from 3.13 to 5.17 by 1981, then stayed around 5. Men's estimated lifetime probability of dying from mesothelioma rose up to the 1964–8 birth cohort, though the increase was not statistically significant. All four assumptions gave about 20 000 deaths among men and 2900 among women from 1996 to 2020. After 2020 the projections diverged widely. The authors concluded that predictions to 2020 were reliable. They also concluded that the lack of a trend in women did not support an important role for environmental asbestos exposure. They cautioned that the estimates rested on extrapolating regional studies.

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: Analysis of national death-certificate data with an age-cohort statistical model, used to estimate past mesothelioma mortality and project future deaths under four hypotheses
• Who was studied: Men and women in France who died of pleural cancer (ICD-9 code 163) at ages 25 to 89, 1950 to 1995, grouped into birth cohorts from 1864–8 to 1964–8; mesothelioma deaths were estimated from these using correction factors from two regional studies (Ile de France and Provence Alpes Côte d'Azur-Corse) and the FRANCIM cancer registries
• Exposure: No individual exposure data. The study looked at national mortality against the background of national asbestos imports. The authors noted that French imports had a larger proportion of chrysotile than British imports, and that total French imports were higher and later than in the United Kingdom.
• Main results:
  • To estimate all mesothelioma deaths (N) from pleural cancer deaths coded 163 (D163), the authors used correction factors: N = 0.797 × D163 for men and N = 0.483 × D163 for women.
  • Among men, age-standardised mesothelioma mortality (per 1 000 000, standardised to the 1950 French population) increased from 5.81 to 25.75 between 1950 and 1995, an increase of about 343%.
  • Among women, age-standardised mortality increased from 3.13 to 5.17 between 1950 and 1981 and then stabilised around 5, a total increase of 75% over 1950 to 1995.
  • Among men, the estimated lifetime probability of death from mesothelioma increased continuously from the 1864–8 to the 1964–8 birth cohort. The increase was not significant, because the last two probabilities were very imprecise. For the 1964–8 cohort the 95% CI was 0.00075% to 0.514%.
  • Among women, the lifetime probability increased up to 0.043% for the 1934–8 cohort and then decreased to 0.01% for the last cohort.
  • Under all four hypotheses, predictions were close until 2020: about 1040 annual deaths among men and 115 among women in 2020. About 20 000 deaths among men and 2900 among women were projected for 1996 to 2020.
  • After 2020 the hypotheses diverged. The pessimistic hypothesis (H4) predicted 2200 male deaths per year in 2050 (135 for women), while the optimistic hypothesis (H1) predicted fewer than 450 annual male deaths (15 for women).
  • The authors compared their projection with earlier published estimates by Peto et al (Great Britain) and Price (United States). Expected mesothelioma deaths per 10 000 000 inhabitants for 1996 to 2020 were 1660 in Great Britain, 430 in France and 280 in the United States. The authors reported a ratio of about 1:4.5 between French and British amphibole imports.
• The authors' conclusion: The authors concluded that future mesothelioma deaths in France could be reliably predicted up to 2020: about 20 000 deaths in men from 1996 to 2020. They found the men's lifetime probability still increasing (although not significantly) in recent generations. They concluded that the absence of a trend in women did not support the hypothesis that environmental exposure to asbestos plays an important part in mortality. They called for national mesothelioma registries.
• Limitations the authors state:
  • National mesothelioma mortality was estimated indirectly from pleural cancer mortality by extrapolating regional studies made at a single time point, so the authors urged caution.
  • Estimates for the last two birth cohorts were based on very few deaths, so uncertainty was large and increases or decreases were not significant.
  • After 2020 the predictions varied strongly, and the authors could not determine which of the four hypotheses was most realistic.
  • Because mesothelioma develops decades after exposure begins, the data reflected exposure before 1975, and recent changes in airborne asbestos could not be evaluated.
  • More precise results would require national mesothelioma registries based on representative samples.

Topics

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

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

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