Global burden of mesothelioma attributable to occupational asbestos exposure in 204 countries and territories: 1990-2019

Our plain-English summary of Global burden of mesothelioma attributable to occupational asbestos exposure in 204 countries and territories: 1990-2019, by Z. Chen, Y. Cai, T. Ou, et al (Journal of Cancer Research and Clinical Oncology, 2024).

The study

• Authors: Z. Chen, Y. Cai, T. Ou, H. Zhou, H. Li, Z. Wang, K. Cai
• Journal: Journal of Cancer Research and Clinical Oncology
• Published: 2024;150(5):282
• Cited by: 19 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Malignant mesothelioma, a rare and aggressive cancer primarily caused by occupational asbestos exposure, has a poor prognosis. This study leverages the Global Burden of Disease (GBD) 2019 dataset to analyze the burden of mesothelioma linked to occupational asbestos exposure from 1990 to 2019. The analysis includes the number of mesothelioma deaths and disability-adjusted life years (DALYs) attributable to occupational asbestos exposure, focusing on trends in age-standardized mortality rate (ASMR) and age-standardized disability-adjusted life-year rate (ASDR) by year, age, sex, country, region, and Socio-demographic Index (SDI). In 2019, 91.7% of mesothelioma deaths and 85.2% of DALYs were attributable to occupational asbestos exposure, resulting in 26,820 (95% UI 24,312-28,622) deaths and 569,429 (95% UI 509,956-617,484) DALYs. Despite a decline in ASMR and ASDR from 1990 to 2019, the absolute number of deaths and DALYs almost doubled. The United States reported the highest number of mesothelioma deaths, while China had the highest number of DALYs. Age-specific mortality rates and DALYs decreased in the 25-74 age group but increased in the 75+ age group. In conclusion, occupational asbestos exposure remains the primary cause of mesothelioma worldwide, with an increasing number of deaths and DALYs. The highest incidence rates are observed in high-income areas, and rates are rising in low-income areas. It is crucial to raise awareness about the hazards of asbestos to reduce the global burden of mesothelioma linked to occupational exposure.

© 2024. The Author(s).

In plain English

This study analysed Global Burden of Disease (GBD) 2019 estimates for 204 countries and territories, 1990 to 2019. It examined mesothelioma deaths and disability-adjusted life years (DALYs, years of healthy life lost) attributed to occupational asbestos exposure. Worldwide, about 91.7% of mesothelioma deaths and 85.2% of DALYs were attributed to this exposure. In 2019 that meant 26,820 deaths (95% uncertainty interval 24,312 to 28,622) and 569,429 DALYs (509,956 to 617,484), about 90% and 70% more than in 1990. Age-standardized rates fell slightly. The 2019 age-standardized death rate was 0.33 per 100,000 (95% uncertainty interval 0.3 to 0.36), with an average annual change of minus 0.22% (95% confidence interval minus 0.29 to minus 0.16). High socio-demographic index regions had the most deaths and highest rates, Australasia had the highest regional rates, and rates rose in low-middle index regions. The United States had the most deaths, China the most DALYs. Rates fell at ages 25 to 74 and rose at 75 and older. The authors concluded that occupational asbestos exposure is the leading cause of mesothelioma deaths and DALYs worldwide. Neither the study nor the database distinguished fiber types.

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 (GBD) 2019 estimates (descriptive trend analysis with age-standardized rates, estimated annual percentage changes, correlation and cluster analyses)
• Who was studied: GBD 2019 estimates of mesothelioma deaths and DALYs attributed to occupational asbestos exposure in 204 countries and territories, 1990 to 2019, broken down by year, age, sex, 21 regions and five socio-demographic index (SDI) levels
• Exposure: Occupational asbestos exposure as defined by the GBD 2019 risk factor. Asbestos fiber types were not distinguished.
• Main results:
  • Globally, about 91.7% of mesothelioma deaths and 85.2% of mesothelioma DALYs were attributed to occupational asbestos exposure
  • In 2019 there were 26,820 (95% UI 24,312 to 28,622) mesothelioma deaths and 569,429 (95% UI 509,956 to 617,484) DALYs attributed to occupational asbestos exposure worldwide
  • Global attributable deaths and DALYs rose by approximately 90% and 70% respectively compared with 1990
  • The global age-standardized mortality rate in 2019 was 0.33 per 100,000 (95% UI 0.3 to 0.36) and the age-standardized DALY rate was 6.91 per 100,000 (95% UI 6.18 to 7.48). Both declined from 1990 to 2019, with estimated annual percentage changes of -0.22% (95% CI -0.29 to -0.16) and -0.54% (95% CI -0.6 to -0.49).
  • The High SDI region had the most attributable deaths (14,377, 95% UI 13,185 to 15,193) and DALYs (262,335, 95% UI 243,964 to 276,666) in 2019, each more than 45% of the global total
  • Age-standardized mortality and DALY rates in Low-middle SDI regions showed a significant upward trend from 1990 to 2019 (Table 1: annual changes 1.13% and 1.03%)
  • Among geographic regions, Australasia had the highest age-standardized mortality and DALY rates
  • By country in 2019, the United States had the most attributable deaths, followed by the United Kingdom. China had the most attributable DALYs, followed by the United States.
  • Georgia had the fastest increase in age-standardized mortality and DALY rates from 1990 to 2019, with annual changes of 11.3% (95% CI 9.12 to 13.53) and 12.28% (95% CI 9.94 to 14.67)
  • Peru had the fastest decrease in age-standardized mortality and DALY rates from 1990 to 2019
  • Globally, mortality and DALY rates fell from 1990 to 2019 in people aged 25 to 74 and rose in those over 75
  • In 2019 most attributable deaths occurred at ages 65 to 84, with the peak at ages 75 to 79
  • Across regions in 2019, age-standardized mortality and DALY rates were correlated with SDI (R = 0.529 and R = 0.519, both p less than 0.001)
• The authors' conclusion: The authors concluded that occupational asbestos exposure is the leading cause of mesothelioma deaths and DALYs worldwide
• Limitations the authors state:
  • There were no quantitative measures of occupational asbestos exposure, and some patients do not know they were exposed
  • Patient screening is not well established in some less developed countries, which may reduce the accuracy and reliability of the findings
  • Asbestos policies vary widely between countries, making it hard to link the findings to asbestos bans
  • Different types of asbestos were not distinguished in the study or in the GBD 2019 database
  • GBD 2019 does not separate the histological subtypes of mesothelioma

Topics

Medical terms in this study, explained in our Lexicon: Mesothelioma, Asbestos Exposure, Malignant Mesothelioma, Prognosis, Incidence, Occupational Exposure.

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