Mesothelioma mortality in Great Britain from 1968 to 2001

Our plain-English summary of Mesothelioma mortality in Great Britain from 1968 to 2001, by D.M. McElvenny, A.J. Darnton, M.J. Price, et al (Occupational Medicine, 2005).

The study

• Authors: D.M. McElvenny, A.J. Darnton, M.J. Price, J.T. Hodgson
• Journal: Occupational Medicine
• Published: 2005;55(2):79-87
• Cited by: 84 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Background: The British mesothelioma register contains all deaths from 1968 to 2001 where mesothelioma was mentioned on the death certificate.

Aims: To present summary statistics of the British mesothelioma epidemic including summaries by occupation and geographical area.

Methods: Standardized mortality ratios (SMRs) were calculated for local authorities, unitary authorities and counties. Temporal trends in SMRs were also examined. Proportional mortality ratios (PMRs) were calculated using the Southampton (based on the 1980 standard occupational classification) coding scheme. Temporal trends in PMRs were also examined.

Results: The annual number of mesothelioma deaths has increased from 153 in 1968 to 1848 in 2001. Current deaths in males account for about 85% of the cases. The areas of West Dunbartonshire (SMR 637), Barrow-in-Furness (593), Plymouth (396) and Portsmouth (388) have the highest SMRs over the period 1981-2000. The occupations with the highest PMRs are metal plate workers (PMR 503), vehicle body builders (526), plumbers and gas fitters (413) and carpenters (388).

Conclusions: These data reinforce earlier findings that geographical areas and occupations associated with high exposure to asbestos in the past continue to drive the mesothelioma epidemic in Great Britain. However, the trends over time suggest a change in the balance of risk away from traditional asbestos exposure industries to industries where one could describe the exposure as secondary, such as plumbers and gas fitters, carpenters, and electricians.

In plain English

The authors analysed Great Britain's mesothelioma death register for 1968 to 2001. Annual deaths rose from 153 in 1968 to 1848 in 2001, and men accounted for about 85% of current deaths. For 1981 to 2000, the highest male standardized mortality ratios (SMRs; 100 equals the British average) were in areas the authors linked to past shipbuilding, including West Dunbartonshire (637; 95% confidence interval 547 to 738) and Barrow-in-Furness (593; 499 to 699). In women the highest were mainly in areas linked to asbestos product manufacture, led by Barking and Dagenham (649; 486 to 849). Among men aged 16 to 74, by last job, the highest proportional mortality ratios included vehicle body builders (526; 419 to 652), metal plate workers (502; 444 to 565), plumbers and gas fitters (413; 381 to 446) and carpenters (388; 362 to 413). The authors concluded that areas and jobs with high past asbestos exposure still drive the epidemic, but risk is shifting toward 'secondary' exposure such as building maintenance trades. They noted that residence at death and last full-time job likely dilute differences.

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-register data: standardized mortality ratios (SMRs) by geographical area and proportional mortality ratios (PMRs) by occupation, with tests for trend over time
• Who was studied: All deaths in Great Britain from 1968 to 2001 where the death certificate mentioned mesothelioma. The geographical analysis covered deaths from 1981 to 2000. The occupational analysis covered deaths at ages 16 to 74 from 1980 to 2000, excluding 1981. It also excluded deaths where the occupation given was not the deceased's own (310 men and 945 women).
• Exposure: Asbestos exposure was not measured directly. The study compared mesothelioma deaths by area of residence at death and by last occupation recorded on the death certificate. No fiber types were analysed.
• Main results:
  • Annual mesothelioma deaths in Great Britain rose from 153 in 1968 to 1848 in 2001.
  • Men accounted for about 85% of current deaths, meaning deaths at the time of the study.
  • For 1999 to 2001, the crude mortality rate was 70.9 per million for males aged 20 or over and 10.7 per million for females.
  • In men, 1981 to 2000, the highest area SMRs were in areas associated with past shipbuilding. West Dunbartonshire had 178 deaths (SMR 637; 95% CI 547 to 738). Barrow-in-Furness had 140 deaths (SMR 593; 95% CI 499 to 699). Plymouth had 298 deaths (SMR 396; 95% CI 352 to 443). Portsmouth had 222 deaths (SMR 388; 95% CI 339 to 443).
  • In women, the highest area SMRs were mainly in areas associated with asbestos product manufacture. Barking and Dagenham had 53 deaths (SMR 649; 95% CI 486 to 849). Sunderland had 79 deaths (SMR 575; 95% CI 455 to 716). Blackburn with Darwen had 31 deaths (SMR 484; 95% CI 329 to 687).
  • In men, the areas where deaths rose significantly faster than the British average (at the 1% level) were not those traditionally associated with high occupational asbestos exposure. The areas where deaths rose more slowly, such as Portsmouth, Plymouth, Glasgow City, West Dunbartonshire and Barrow-in-Furness, were traditional high-exposure areas.
  • Men aged 16 to 74, by last occupation: metal plate workers had 265 deaths (PMR 502; 95% CI 444 to 565). Vehicle body builders had 83 deaths (PMR 526; 95% CI 419 to 652).
  • Men aged 16 to 74, by last occupation: plumbers and gas fitters had 619 deaths (PMR 413; 95% CI 381 to 446). Carpenters had 887 deaths (PMR 388; 95% CI 362 to 413). Electricians had 496 deaths (PMR 279; 95% CI 255 to 304).
  • The authors interpreted the occupational results as suggesting that construction-trade occupations, rather than asbestos use or manufacture, are now at highest risk.
  • Women aged 16 to 74, by last occupation: the highest PMRs were for metal plate workers (2 deaths; PMR 2746; 95% CI 346 to 10321), chemical workers (15 deaths; PMR 554; 95% CI 310 to 913) and plastics workers (3 deaths; PMR 1080; 95% CI 221 to 3131).
  • In men, the only occupation with a trend rising significantly faster than the British average (at the 1% level) was other electronic maintenance engineers. Chemical workers, metal plate workers and construction workers not elsewhere classified rose more slowly.
  • Among deaths before 1993, the proportion of peritoneal mesothelioma was higher in females (12%) than in males (6%).
• The authors' conclusion: The authors concluded that areas and occupations with high past asbestos exposure continue to drive the mesothelioma epidemic in Great Britain. They added that trends over time reflect a changing balance of risk toward secondary exposure, such as building maintenance trades.
• Limitations the authors state:
  • Areas were assigned by residence at death, not where exposure occurred. The authors said this likely dilutes the differences between high-risk and low-risk areas.
  • PMRs show only relative mortality between occupations. SMRs by occupation could not be calculated because national mortality data are not routinely coded for occupation.
  • Using the last full-time job recorded on the death certificate dilutes the observed differences between occupations. The authors said the potential for dilution is considerable because workers move to more sedentary jobs before retirement.
  • Asbestos manufacturing workers do not share a single occupation code, so they could not be identified as a high-risk group.
  • Improved diagnosis over time and the introduction of ICD10 coding may have affected the number of deaths recorded.
  • After medical enquiries to certifying doctors stopped in 1993, the share of deaths with unidentified tumour site rose from around 10 to 20% to over 45%.

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, Death Certificate, standardized mortality ratio (SMR), Proportional mortality, Asbestos Exposure.

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• Estimating the number of asbestos-related lung cancer deaths in Great Britain from 1980 to 2000 — A.J. Darnton, D.M. McElvenny, et al. (2006)
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• Mesothelioma mortality in Brazil, 1980-2003 — F. Pedra, A.T. Tambellini, et al. (2008)
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