Global, regional, and national burden of non-communicable diseases attributable to occupational asbestos exposure 1990-2019 and prediction to 2035: worsening or improving?

Our plain-English summary of Global, regional, and national burden of non-communicable diseases attributable to occupational asbestos exposure 1990-2019 and prediction to 2035: worsening or improving?, by X. Miao, T. Yao, C. Dong, et al (BMC Public Health, 2024).

The study

• Authors: X. Miao, T. Yao, C. Dong, Z. Chen, W. Wei, Z. Shi, T. Xu, J. Shao, Q. Niu, D. Rui, Y. Hu, Y. Yan
• Journal: BMC Public Health
• Published: 2024;24(1):832
• Cited by: 17 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Understanding the burden associated with occupational asbestos exposure on a global and regional scale is necessary to implement coordinated prevention and control strategies. By the GBD Study 2019, we conducted a comprehensive assessment of the non-communicable diseases burden attributable to occupational asbestos exposure. In 2019, 239,330 deaths and 4,189,000 disability-adjusted life years (DALYs) worldwide due to occupational asbestos exposure occurred. 1990-2019, deaths and DALYs attributed to occupational asbestos exposure increased by 65.65% and 43.66%, respectively. Age-standardized mortality rate (ASMR) and age-standardized DALYs rate (ASDR) decreased, with the most rapid declines in high Socio-Demographic Index (SDI) regions, with average annual percent change (AAPC) of - 1.05(95%CI: -1.2, -0.89) and -1.53(95%CI: -1.71, -1.36), respectively. Lung cancer, mesothelioma and ovarian cancer were the top three contributors to the increase in deaths and DALYs, accounting for more than 96%. AAPCs of ASMR and ASDR were positively associated with SDI. Global deaths from occupational asbestos exposure were predicted to increase and ASMR to decrease by 2035, mostly in males. Due consideration should be given to the susceptibility of the elderly, the lag of asbestos onset, and the regional differences, and constantly improve the prevention and control measures of occupational asbestos exposure and related diseases.

© 2024. The Author(s).

In plain English

This study analysed modelled estimates from the Global Burden of Disease (GBD) Study 2019 database, not new data on individuals. It covered 204 countries and territories from 1990 to 2019, looking at deaths and disability-adjusted life years (DALYs, healthy life lost) from lung cancer, mesothelioma, ovarian cancer, larynx cancer and asbestosis attributed to occupational asbestos exposure. The study estimated 239,330 such deaths in 2019 (95% uncertainty interval 179,520 to 299,210): 198,550 in males (141,470 to 258,120) and 40,790 in females (26,140 to 53,160). It estimated 4,189,000 DALYs (3,127,000 to 5,320,000). From 1990 to 2019, these deaths rose 65.65% and DALYs 43.66%, while the global age-standardized death rate fell (average annual percent change −0.92, 95% confidence interval −1.12 to −0.73). Lung cancer, mesothelioma and ovarian cancer accounted for 97% of the 2019 deaths. Rates fell fastest in high Socio-Demographic Index regions and rose most in low-middle ones. A forecasting model predicted that deaths would keep rising to 2035, mainly in males, and the age-standardized rate would fall. The authors noted the data are model reconstructions that may differ from real data. Some figures in the article conflict.

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 modelled estimates, with trend analysis (joinpoint regression) and forecasting to 2035 (Bayesian age-period-cohort model)
• Who was studied: Populations of 204 countries or territories and 21 GBD regions, 1990 to 2019, as represented in the GBD 2019 database
• Exposure: Occupational asbestos exposure as a GBD risk factor, applied to five diseases: lung cancer, mesothelioma, ovarian cancer, larynx cancer and asbestosis. Fiber types, products, jobs and doses were not analysed separately.
• Main results:
  • In 2019, 239,330 deaths worldwide (95% uncertainty interval 179,520 to 299,210) were attributed to occupational asbestos exposure. Of these, 40,790 (26,140 to 53,160) were in females and 198,550 (141,470 to 258,120) were in males.
  • In 2019, 4,189,000 DALYs worldwide (95% uncertainty interval 3,127,000 to 5,320,000) were attributed to occupational asbestos exposure
  • Globally from 1990 to 2019, the number of attributable deaths rose by 65.65% and the number of DALYs by 43.66%
  • Globally, the age-standardized mortality rate fell (AAPC −0.92, 95% CI −1.12 to −0.73), and so did the age-standardized DALY rate (AAPC −1.29, 95% CI −1.47 to −1.12)
  • Lung cancer, mesothelioma and ovarian cancer were the three leading causes of attributable death in 2019, together making up 97% of the deaths counted
  • In 2019, high-SDI regions had the most attributable deaths (141,210) and DALYs (2,286,000)
  • From 1990 to 2019, high-SDI regions had the largest fall in rates: AAPC −1.05 (95% CI −1.2 to −0.89) for the age-standardized mortality rate and −1.53 for the age-standardized DALY rate
  • The low-middle SDI region had the largest increase in rates (AAPC of the age-standardized mortality rate 1.57, 95% CI 1.23 to 1.92)
  • Among the 21 GBD regions, Western Europe and high-income North America ranked first and second for numbers of attributable deaths or DALYs
  • Of the five diseases, mesothelioma, asbestosis and lung cancer had the highest share of their deaths attributed to occupational asbestos exposure (population attributable fraction)
  • At the national level, the authors described the change in rates (AAPC) as positively correlated with SDI in 2019, with correlation coefficients of 0.09 for the mortality rate and 0.05 for the DALY rate; no p-values were given
  • The forecasting model predicted that attributable deaths would keep increasing to 2035, to 219,235 in males and 53,073 in females, with males driving the increase and the rise slowing. The age-standardized mortality rate was predicted to decline.
• The authors' conclusion: The authors concluded that although age-standardized death and DALY rates have declined globally, the burden remains fairly high. They attributed this to factors such as early accumulation effects, delays in implementing bans and inadequate diagnostic techniques.
• Limitations the authors state:
  • The data are model reconstructions from the GBD 2019 database and may differ from real data
  • Because supervision and prevention of asbestos-related diseases differ between regions, data collection is insufficient
  • Interactions between asbestos-related diseases and other possible risks were not sufficiently considered

Topics

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

Related studies

• Global and regional burden of disease and injury in 2016 arising from occupational exposures: a systematic analysis for the Global Burden of Disease Study 2016 — GBD 2016 Occupational Risk Factors Collaborators (2020)
• Global burden of tracheal, bronchus, and lung cancer attributable to occupational carcinogens in 204 countries and territories, from 1990 to 2019: results from the global burden of disease study 2019 — Y. Zhang, M. Mi, et al. (2023)
• Global, regional, and national burden of ovarian cancer among young women during 1990-2019 — Q. Zhuang, G. Gu, et al. (2025)
• Global burden of mesothelioma attributable to occupational asbestos exposure in 204 countries and territories: 1990-2019 — Z. Chen, Y. Cai, et al. (2024)
• The global burden of cancers attributable to occupational factors, 1990-2021 — B. Zou, P. Wu, et al. (2025)
• The Burden of Trachea, Bronchus, and Lung Cancer Attributable to Occupational Exposure From 1990 to 2019 — H. Li, J. Guo, et al. (2022)

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