Global, regional and national mortality burden of laryngeal cancer attributable to occupational exposure to sulfuric acid and asbestos: 1990-2021 and projections to 2040

Our plain-English summary of Global, regional and national mortality burden of laryngeal cancer attributable to occupational exposure to sulfuric acid and asbestos: 1990-2021 and projections to 2040, by X. Gong, Y. Xu, Y. Hao, et al (Frontiers in Public Health, 2025).

The study

• Authors: X. Gong, Y. Xu, Y. Hao, M. Yi, C. Yuan, Z. Zheng, J. Gong, G. Shen, Y. Dong
• Journal: Frontiers in Public Health
• Published: 2025;13:1602789
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Laryngeal cancer (LC) is the most prevalent form of head and neck cancer, significantly impacting patients' health. Occupational exposure to sulfuric acid (OESA) and asbestos (OEA) is a recognized risk factor for LC, but the associated mortality burden remains unclear. This study aimed to evaluate the global trends of LC attributable to OESA and OEA, and to project future trends.

Methods: Based on the Global Burden of Disease Study 2021, we analyzed the number of deaths, age-standardized death rates (ASDR), and estimated annual percentage changes by age, sex, and socio-demographic index (SDI) of LC attributed to OESA and OEA. Decomposition analysis was used to identify the drivers of disease burden changes. Frontier analysis was used to estimate achievable outcomes based on development levels. Additionally, Bayesian age-period-cohort model was used to predict future trends up to 2040.

Results: In 2021, global LC deaths attributable to OESA and OEA were 3,612.35 (95% uncertainty intervals (UI): 1,504.31-6,492.29) and 3,392.00 (95% UI: 1,892.13-5,134.88), respectively, representing increases of 37.5% and 21.4%, respectively, from 1990. The ASDRs for OESA and OEA in 2021 were both 0.04 per 100,000 (95% UI: 0.02-0.07 and 0.02-0.06, respectively), both lower than in 1990. LC deaths attributable to OESA and OEA mainly occur in elderly patients, and men consistently showed higher LC deaths and ASDR than females. The ASDR for OESA was negatively correlated with the SDI, while OEA was positively correlated. Decomposition analysis highlighted differences in disease burden drivers across SDI regions. Frontier analysis showed that countries like Cuba and Pakistan were farthest from the OESA-related mortality burden frontier, while Monaco and Lesotho were farthest from OEA-related mortality burden. From 2022 to 2040, LC deaths attributable to OESA and OEA are projected to increase to 4,810.90 (95% UI: 1,628.04-8,010.74) and 3,648.48 (95% UI: 1,016.75-6,322.42), respectively.

Conclusions: Although the ASDR decreased from 1990 to 2021, OESA and OEA remain contributors to LC mortality worldwide, with the number of deaths expected to increase over the next two decades. Disease burden varies significantly across SDI regions, suggesting that preventive measures should be tailored to specific SDI levels.

Copyright © 2025 Gong, Xu, Hao, Yi, Yuan, Zheng, Gong, Shen and Dong.

In plain English

This study analyzed Global Burden of Disease Study 2021 estimates for 204 countries and territories, 1990 to 2021. The authors looked at laryngeal cancer deaths attributed to occupational exposure to asbestos and to sulfuric acid; asbestos fiber types were not named. For asbestos, estimated global deaths were 3,392.00 in 2021 (95% uncertainty interval 1,892.13 to 5,134.88), up 21.4% from 2,794.84 in 1990 (1,605.96 to 4,157.60). The asbestos-related age-standardized death rate fell from 0.08 (0.04 to 0.11) to 0.04 (0.02 to 0.06) per 100,000 people. For sulfuric acid, estimated deaths were 3,612.35 in 2021 (1,504.31 to 6,492.29), up 37.5% from 1990. Men had more deaths and higher rates than women. The asbestos-related rate was positively correlated with the socio-demographic index, a measure of development. Western Europe had the most asbestos-related deaths. A forecasting model projected 3,648.48 asbestos-related deaths in 2040 (1,016.75 to 6,322.42). The authors concluded that both exposures remain contributors to laryngeal cancer deaths worldwide. They noted that limited data from some countries may have led to underestimates.

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) 2021 estimates, with trend analysis (estimated annual percentage change), decomposition analysis, frontier analysis and Bayesian age-period-cohort projections to 2040
• Who was studied: Modelled laryngeal cancer (ICD-10 C32) deaths in 204 countries and territories and 21 regions, 1990 to 2021, by sex, age and socio-demographic index level
• Exposure: The GBD risk factors 'Occupational exposure to asbestos' and 'Occupational exposure to sulfuric acid'. No fiber types, products, jobs or doses are specified.
• Main results:
  • Global laryngeal cancer deaths attributable to occupational asbestos exposure were estimated at 3,392.00 (95% UI: 1,892.13–5,134.88) in 2021, a 21.4% increase from 2,794.84 (95% UI: 1,605.96–4,157.60) in 1990.
  • The global age-standardized death rate attributable to asbestos fell by 50%, from 0.08 (95% UI: 0.04–0.11) per 100,000 in 1990 to 0.04 (95% UI: 0.02–0.06) per 100,000 in 2021. The estimated annual percentage change was −2.01 (95% CI: −2.09 to −1.93).
  • For sulfuric acid, global attributable deaths were 3,612.35 (95% UI: 1,504.31–6,492.29) in 2021, up 37.5% from 1990. The age-standardized death rate fell from 0.06 to 0.04 per 100,000.
  • In 2021, asbestos-attributable deaths rose steeply from age 50–54. They peaked at 70–74 years in males and 80–84 years in females. Men showed higher deaths and rates than women.
  • The asbestos-attributable death rate was positively correlated with the socio-demographic index at the regional level (R = 0.5997, p less than 0.001) and at the national level (R = 0.4900, p less than 0.001).
  • Western Europe had the highest number of asbestos-attributable deaths in both 1990 (1,407.76) and 2021 (1,178.05). Among high SDI regions as a group, deaths were 1,465.99 in 1990 and 1,512.39 in 2021.
  • Nationally, Monaco had the highest asbestos-attributable death rate in 2021 (0.36 per 100,000, 95% UI: 0.19–0.60), followed by Lesotho, Croatia, France and Namibia.
  • The decomposition analysis attributed the global increase in asbestos-attributable deaths largely to population growth (292.53%) and aging (175.2%).
  • The model projected asbestos-attributable deaths to rise from 3,441.53 (95% UI: 2,950.53–3,937.46) in 2022 to 3,648.48 (95% UI: 1,016.75–6,322.42) in 2040. The projected rate declined from 0.06 to 0.04 per 100,000.
• The authors' conclusion: The authors concluded that, although age-standardized death rates fell from 1990 to 2021, occupational exposure to sulfuric acid and to asbestos remain contributors to laryngeal cancer deaths worldwide. They expected the number of deaths to increase over the next two decades. They also concluded that the burden varied across development levels.
• Limitations the authors state:
  • Limited data from some countries may have led to underestimation of the burden and trends.
  • The GBD datasets do not account for racial factors that could influence disease burden.
  • Laryngeal cancer diagnosis may be affected by people not seeking medical attention for symptoms, which may affect the accuracy of mortality statistics.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Throat and laryngeal cancer.

Medical terms in this study, explained in our Lexicon: Laryngeal Cancer, Occupational Exposure.

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