Mortality from mesothelioma of the pleura during 1968-78 in England and Wales

Our plain-English summary of Mortality from mesothelioma of the pleura during 1968-78 in England and Wales, by M.J. Gardner, E.D. Acheson, P.D. Winter (British Journal of Cancer, 1982).

The study

• Authors: M.J. Gardner, E.D. Acheson, P.D. Winter
• Journal: British Journal of Cancer
• Published: 1982;46(1):81-8
• Cited by: 35 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text
• In J-M's library: Johns-Manville's company medical library held a copy (J-M no. 000674).

Abstract

The geographical distribution of mortality from mesothelioma of the pleura during the years 1968-78 in England and Wales has been studied using extracts from the death records held by the Office of Population Censuses and Surveys. Using the national death rate as standard, Local Authority areas with raised mortality are identified. The patterns are somewhat different for each sex. In men the high-mortality areas are mainly the major ports where shipbuilding and repairing have been concentrated, whereas in women areas where gas masks are manufactured are predominant. In both sexes there are also high death rates on the eastern side of London. Nearly all the areas of high mortality are known to have had a major asbestos-using industry in the past. Over the 11-year period the annual number of deaths from pleural mesothelioma rose by approximately 75%. This marked increase was virtually confined to men, in whom the number of deaths had reached almost 200 per annum by 1978. The indications are that the effect of past high exposures, in particular to amphibole asbestos, have not yet reached a peak in terms of mortality. On the other hand imports and usage of amphiboles, particularly crocidolite, have decreased rapidly since the mid-1960s, and dust levels in the working environment have improved even more radically.

In plain English

This study used death records held by the Office of Population Censuses and Surveys to map deaths coded to malignant neoplasm of the pleura (ICD 163.0, which the authors treated as pleural mesothelioma) in England and Wales during 1968-78. It covered 1366 Local Authority areas, using national death rates as the standard. There were 1860 such deaths: 1406 in men and 454 in women. Yearly deaths rose by about 75% over the period, almost entirely in men, reaching almost 200 a year in men by 1978. In men, areas with raised mortality were mainly major ports with shipbuilding and repairing, plus a cluster of east London boroughs. 557 of the 1406 male deaths were among residents of the 38 areas identified. In women, raised areas included places where gas masks with crocidolite filters were made, and east London. The study had no direct evidence linking individual deaths to these industries. The authors concluded that the results supported the view that a high percentage of pleural mesothelioma deaths is associated with high levels of past asbestos exposure.

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: Geographical analysis of national death records (area-level standardized mortality ratios); no individual exposure data
• Who was studied: All registered deaths coded to ICD 163.0 (malignant neoplasm of the pleura) in England and Wales, 1968-78, across 1366 Local Authority areas: 1860 deaths, 1406 (76%) in men and 454 (24%) in women
• Exposure: Not measured for individuals. Areas with raised death rates were matched to known past asbestos-using industries reported in other studies: shipbuilding, repairing and naval dockyards; gas mask manufacture (crocidolite filters); textiles; insulation materials; cement; railway work; asbestos cement; construction materials
• Main results:
  • Over the 11 years, the annual number of pleural mesothelioma deaths rose by about 75%. The increase was virtually confined to men, whose annual deaths reached almost 200 by 1978.
  • Age-specific death rates were considerably higher in men than in women at every age.
  • In men, high-mortality areas were mainly major ports with shipbuilding, repairing and naval dockyards, plus a cluster of London boroughs. 557 (40%) of the 1406 male deaths were among residents of the 38 areas shown on the map. The highest SMR in men was in Barrow-in-Furness: 34 deaths observed against 2.0 expected, SMR 1735.
  • In women, ports and dockyards were absent from the high-mortality areas. There was a cluster in Lancashire around Leyland and Blackburn, and also Nottingham, which the authors related to the manufacture of gas masks with crocidolite asbestos filters. The highest SMR in women was in Leyland: 4 deaths observed against 0.2 expected, SMR 2153.
  • In Greater London, 11 boroughs or adjacent areas had raised mortality in men, women or both. All were in the eastern part, with contiguous boundaries, and all but 2 bordered the River Thames.
  • Canvey Island was the only high-mortality area for which the authors had no information suggesting heavy past asbestos exposure.
  • The Employment Medical Advisory Service mesothelioma register recorded 1672 pleural mesotheliomas over the same period, about 10% fewer than the 1860 deaths coded to ICD 163.0.
• The authors' conclusion: The authors concluded that the results support the view that a high percentage of pleural mesothelioma deaths is associated with high levels of past asbestos exposure. They could not separate the effects of crocidolite, amosite and chrysotile. They said the prominence of shipbuilding and respirator-assembly areas is consistent with other evidence that amphiboles are more important than chrysotile in causing pleural mesothelioma in men. They also judged it not unlikely that the numbers of deaths would continue to increase.
• Limitations the authors state:
  • Deaths coded to ICD 163.0 will not include all pleural mesothelioma deaths, and the code also contains other malignant pleural tumours.
  • The study had no direct evidence linking any reported death to work in the listed industries. The links rest on other published studies.
  • Deaths before 1968 were spread across various codes and could not be included.
  • Peritoneal mesothelioma could not be analyzed in the same way, because fewer than 20% of deaths coded to malignant neoplasm of the peritoneum were mesothelial tumours.
  • Some areas with known asbestos factories and mesothelioma cases did not appear on the maps. Possible reasons include death certification, workers living in a neighbouring area, and migration after leaving employment. The authors said these effects dilute the power of this kind of indirect study.

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, Pleural Mesothelioma, Amphibole Asbestos, Amphibole Group, Crocidolite.

Related studies

• Mortality of asbestos workers in England and Wales 1971-81 — J.T. Hodgson, R.D. Jones (1986)
• Mesothelioma of the peritoneum during 1967-82 in England and Wales — M.J. Gardner, R.D. Jones, et al. (1985)
• Work-related mortality in England and Wales, 1979-2000 — D. Coggon, E.C. Harris, et al. (2010)
• Trends in mortality from occupational hazards among men in England and Wales during 1979-2010 — E.C. Harris, K.T. Palmer, et al. (2016)
• Women's occupation and cancer: preliminary analysis of cancer registrations in England and Wales, 1971-1990 — J. Simpson, E. Roman, et al. (1999)
• Variation in number of general practitioner consultations before hospital referral for cancer: findings from the 2010 National Cancer Patient Experience Survey in England — G. Lyratzopoulos, R.D. Neal, et al. (2012)

Browse more research in British Journal of Cancer, or return to medical research.