Malignant Mesothelioma Mortality - United States, 1999-2015

Our plain-English summary of Malignant Mesothelioma Mortality - United States, 1999-2015, by J.M. Mazurek, G. Syamlal, J.M. Wood, et al (MMWR. Morbidity and Mortality Weekly Report, 2017).

The study

• Authors: J.M. Mazurek, G. Syamlal, J.M. Wood, S.A. Hendricks, A. Weston
• Journal: MMWR. Morbidity and Mortality Weekly Report
• Published: 2017;66(8):214-218
• Cited by: 119 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Malignant mesothelioma is a neoplasm associated with occupational and environmental inhalation exposure to asbestos* fibers and other elongate mineral particles (EMPs) (1-3). Patients have a median survival of approximately 1 year from the time of diagnosis (1). The latency period from first causative exposure to malignant mesothelioma development typically ranges from 20 to 40 years but can be as long as 71 years (2,3). Hazardous occupational exposures to asbestos fibers and other EMPs have occurred in a variety of industrial operations, including mining and milling, manufacturing, shipbuilding and repair, and construction (3). Current exposures to commercial asbestos in the United States occur predominantly during maintenance operations and remediation of older buildings containing asbestos (3,4). To update information on malignant mesothelioma mortality (5), CDC analyzed annual multiple cause-of-death records† for 1999-2015, the most recent years for which complete data are available. During 1999-2015, a total of 45,221 deaths with malignant mesothelioma mentioned on the death certificate as the underlying or contributing cause of death were reported in the United States, increasing from 2,479 deaths in 1999 to 2,597 in 2015 (in the same time period the age-adjusted death rates§ decreased from 13.96 per million in 1999 to 10.93 in 2015). Malignant mesothelioma deaths increased for persons aged ≥85 years, both sexes, persons of white, black, and Asian or Pacific Islander race, and all ethnic groups. Despite regulatory actions and the decline in use of asbestos the annual number of malignant mesothelioma deaths remains substantial. The continuing occurrence of malignant mesothelioma deaths underscores the need for maintaining measures to prevent exposure to asbestos fibers and other causative EMPs and for ongoing surveillance to monitor temporal trends.

In plain English

CDC researchers analyzed U.S. death certificates for 1999–2015 on malignant mesothelioma deaths among people aged 25 and older. They counted 45,221 deaths in which mesothelioma was listed as the underlying or a contributing cause, and 79.8% of these were males. The yearly number of deaths rose 4.8%, from 2,479 in 1999 to 2,597 in 2015. Over the same years the age-adjusted death rate fell 21.7%, from 13.96 to 10.93 per million. Age-specific rates fell significantly among people aged 45–74 and rose among those 85 and older. An unspecified-site code appeared for 77.5% of decedents, pleura for 7.4% and peritoneum for 4.1%; some had more than one site listed. In 23 states with job information for selected years, mesothelioma deaths were higher than expected in 11 industries and 17 occupations. The highest proportionate mortality ratios were for insulation workers (26.9; 95% CI 16.2–42.0) and for ship and boat building (6.7; 4.3–9.9). No individual asbestos exposure data were available. The authors concluded that deaths remain substantial despite regulation, that deaths in people under 55 suggest ongoing exposure, and that prevention and surveillance should continue.

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 multiple cause-of-death (death certificate) records, with proportionate mortality ratios by industry and occupation
• Who was studied: 45,221 U.S. decedents aged 25 or older with malignant mesothelioma on the death certificate, 1999–2015. Industry and occupation analysis covered 1,830 of 1,900 mesothelioma deaths among residents of 23 states in 1999, 2003, 2004 and 2007.
• Exposure: No direct asbestos exposure or fiber-type data. Industry and occupation as recorded on death certificates, available for 23 states in four years.
• Main results:
  • Of the 45,221 deaths, 36,093 (79.8%) were among males
  • The annual number of deaths increased from 2,479 in 1999 to 2,597 in 2015
  • The age-adjusted death rate decreased 21.7%, from 13.96 per million in 1999 to 10.93 in 2015
  • Age-specific death rates decreased significantly among persons aged 45–54, 55–64 and 65–74, and increased significantly among persons aged 85 or older (p less than 0.001 for each)
  • Anatomic-site codes: pleura 3,351 (7.4%), peritoneum 1,854 (4.1%), unspecified anatomic site 35,068 (77.5%). Site categories overlap because some decedents had more than one site listed.
  • Two states had annualized age-adjusted death rates above 20 per million: Maine (22.06) and Washington (20.10)
  • Among 207 industries and 274 occupations, proportionate mortality ratios were significantly elevated for 11 industries and 17 occupations
  • Highest industry PMR: ship and boat building and repairing, 6.7 (95% CI 4.3–9.9)
  • Highest occupation PMR: insulation workers, 26.9 (95% CI 16.2–42.0)
  • Pipelayers, plumbers, pipefitters and steamfitters had a PMR of 4.8 (95% CI 3.7–6.1)
• The authors' conclusion: The authors concluded that, despite regulation and declining asbestos use, annual mesothelioma deaths remain substantial. They said continuing deaths in people under 55 suggest ongoing exposure, and that prevention efforts and surveillance should be maintained.
• Limitations the authors state:
  • No information on asbestos exposure or work history was available
  • The industry and occupation on the death certificate might not be where exposure occurred
  • The state issuing the death certificate might not be where exposure occurred
  • Trends before 1999 could not be evaluated because mesothelioma had no discrete ICD code before ICD-10
  • Some cases may have been missed because of misdiagnosis or incorrect coding
  • Industry and occupation data came only from selected states and years and might not be nationally representative

Topics

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

Medical terms in this study, explained in our Lexicon: Malignant Mesothelioma, Neoplasm, elongate mineral particles (EMPs), Median Survival, Latency, Occupational Exposure, Death Certificate.

Related studies

• Diseases attributable to asbestos exposure: years of potential life lost, United States, 1999-2010 — K.M. Bang, J.M. Mazurek, et al. (2014)
• Assessment of mortality in the construction industry in the United States, 1984-1986 — C. Robinson, F. Stern, et al. (1995)
• Patterns of care and survival among patients with malignant mesothelioma in the United States — L. Enewold, E. Sharon, et al. (2017)
• Mortality experience of insulation workers in the United States and Canada, 1943--1976 — I.J. Selikoff, E.C. Hammond, et al. (1979)
• Mortality among asbestos products workers in the United States — P.E. Enterline (1965)
• Recent geographic patterns of lung cancer and mesothelioma mortality rates in 49 shipyard counties in the United States, 1970-94 — A. Jemal, D. Grauman, et al. (2000)

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