Global mesothelioma deaths reported to the World Health Organization between 1994 and 2008

Our plain-English summary of Global mesothelioma deaths reported to the World Health Organization between 1994 and 2008, by V. Delgermaa, K. Takahashi, E.K. Park, et al (Bulletin of the World Health Organization, 2011).

The study

• Authors: V. Delgermaa, K. Takahashi, E.K. Park, G.V. Le, T. Hara, T. Sorahan
• Journal: Bulletin of the World Health Organization
• Published: 2011;89(10):716-24, 724A-724C
• Cited by: 306 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Objective: To carry out a descriptive analysis of mesothelioma deaths reported worldwide between 1994 and 2008.

Methods: We extracted data on mesothelioma deaths reported to the World Health Organization mortality database since 1994, when the disease was first recorded. We also sought information from other English-language sources. Crude and age-adjusted mortality rates were calculated and mortality trends were assessed from the annual percentage change in the age-adjusted mortality rate.

Findings: In total, 92,253 mesothelioma deaths were reported by 83 countries. Crude and age-adjusted mortality rates were 6.2 and 4.9 per million population, respectively. The age-adjusted mortality rate increased by 5.37% per year and consequently more than doubled during the study period. The mean age at death was 70 years and the male-to-female ratio was 3.6:1. The disease distribution by anatomical site was: pleura, 41.3%; peritoneum, 4.5%; pericardium, 0.3%; and unspecified sites, 43.1%. The geographical distribution of deaths was skewed towards high-income countries: the United States of America reported the highest number, while over 50% of all deaths occurred in Europe. In contrast, less than 12% occurred in middle- and low-income countries. The overall trend in the age-adjusted mortality rate was increasing in Europe and Japan but decreasing in the United States.

Conclusion: The number of mesothelioma deaths reported and the number of countries reporting deaths increased during the study period, probably due to better disease recognition and an increase in incidence. The different time trends observed between countries may be an early indication that the disease burden is slowly shifting towards those that have used asbestos more recently.

In plain English

This descriptive study analysed mesothelioma deaths recorded in the World Health Organization mortality database, 1994 to 2008. It used death records and did not measure asbestos exposure. In total, 92 253 deaths were reported by 83 countries. The age-adjusted death rate was 4.9 per million (9.0 in males, 1.9 in females), and the average age at death was 70. The recorded site was the pleura (chest lining) in 41.3% of deaths, unspecified in 43.1%, and the peritoneum (abdominal lining) in 4.5%. Europe accounted for 54.0% of deaths and high-income countries for 88%. In 46 countries with more than 5 years of data, the age-adjusted rate rose significantly, by 5.37% a year (95% confidence interval 3.06% to 7.74%). Japan's rate rose significantly (3.46% a year, interval 2.86% to 4.07%) and the United States' fell significantly (annual change −0.84%, interval −1.34% to −0.34%). The authors noted that national data were poorly comparable and that reporting countries held about 29% of the world's population in 2000. They suggested the burden may be shifting toward countries that used asbestos more recently.

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: Descriptive analysis of national death records (mortality data) from the WHO mortality database, with regression analysis of time trends
• Who was studied: Deaths recorded as malignant mesothelioma (ICD-10 category C45) in the WHO mortality database, 1994 to 2008: 92 253 deaths in 83 countries. Countries reported data for 1 to 15 years each.
• Exposure: Not measured. The study analysed death records only and had no data on individual asbestos exposure, fiber types or jobs.
• Main results:
  • For all mesothelioma deaths, the crude mortality rate was 6.2 per million and the age-adjusted rate was 4.9 per million. The mean age at death was 70 years.
  • The age-adjusted mortality rate was 9.0 per million for males and 1.9 per million for females. The male-to-female ratio was 3.6:1.
  • The pleura accounted for 41.3% of all mesothelioma deaths.
  • Unspecified sites accounted for 43.1% of deaths, the peritoneum for 4.5% and the pericardium for 0.3%.
  • Peritoneal mesothelioma made up 7.7% of deaths in females versus 3.6% in males.
  • Europe accounted for almost 50 000 deaths, 54.0% of all deaths worldwide.
  • Oceania (Australia and New Zealand) accounted for 4.6% of deaths but had the highest continental age-adjusted mortality rate, 16.0 per million.
  • 88% of deaths occurred in high-income countries and 12% in middle-income countries, with almost none recorded in low-income countries.
  • 45.2% of deaths occurred in Japan, the United Kingdom or the United States. The United Kingdom had the highest national age-adjusted rate, 17.8 per million.
  • Worldwide, the age-adjusted mortality rate was 5.3 per million in 2001 to 2008 compared with 4.0 per million in 1994 to 2000.
  • Age-specific rates in men peaked at 113 per million in the 80 to 84 age group. In women they peaked at 21 per million in the same age group.
  • The trend analysis used 46 countries that reported for more than 5 years, covering 85 512 deaths.
  • In these 46 countries, the age-adjusted mortality rate for all mesothelioma deaths increased significantly, by 5.37% per year.
  • The 95% confidence interval for the 5.37% annual change in all mesothelioma deaths was 3.06 to 7.74.
  • The annual increase was 5.85% in men and 3.48% in women.
  • The rate rose significantly by 5.54% per year in high-income countries. There was no significant increase in middle- and low-income countries.
  • By continent, there were significant annual increases of 3.67% in Asia and 3.44% in Europe.
  • By country, Japan had a significant annual increase of 3.46% and the United States a significant annual decrease of 0.84%.
  • The 95% confidence interval for Japan's annual change of 3.46% was 2.86 to 4.07.
  • The 95% confidence interval for the United States' annual change of −0.84% was −1.34 to −0.34.
• The authors' conclusion: The authors suggested that, given differing national trends and historical asbestos use, the burden of disease may be shifting towards countries that used asbestos more recently, such as those in Asia and, to a lesser extent, middle- and low-income countries.
• Limitations the authors state:
  • Data from different countries in the WHO database are poorly comparable.
  • Reporting countries covered only about 29% of the world's population in 2000. There were no data from populous countries such as China, India and Indonesia.
  • 26 countries reported fewer than 10 deaths each, and data validity may be a problem there.
  • Deaths coded as malignant neoplasm of the pleura under ICD-9 were not included, so deaths may be underestimated.
  • Relying on the underlying cause of death may have missed a significant proportion of mesothelioma deaths.
  • Developing countries may be prone to misdiagnosis and reporting errors.
  • Figures for more recent years will probably be revised as data entry continues.

Topics

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

Medical terms in this study, explained in our Lexicon: Mesothelioma, Pleura, Peritoneum, Pericardium.

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