Mortality from pleural mesothelioma in Rio de Janeiro, Brazil, 1979-2000: estimation from death certificates, hospital records, and histopathologic assessments

Our plain-English summary of Mortality from pleural mesothelioma in Rio de Janeiro, Brazil, 1979-2000: estimation from death certificates, hospital records, and histopathologic assessments, by G.A. Pinheiro, V.C. Antão, M.M. Monteiro, et al (International Journal of Occupational and Environmental Health, 2003).

The study

• Authors: G.A. Pinheiro, V.C. Antão, M.M. Monteiro, V.L. Capelozzi, M. Terra-Filho
• Journal: International Journal of Occupational and Environmental Health
• Published: 2003;9(2):147-52
• Cited by: 20 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

To obtain information about the occurrence of pleural mesothelioma on a population basis in Brazil, mortality related to pleural tumors in the State of Rio de Janeiro during 1979-2000 was examined. Death certificates with pleural tumors as the main cause of death and hospital records were analyzed, together with histopathologic material, which was reevaluated. Of 217 death certificates coded as pleural tumors, 34.1% were considered wrongly coded. Results after reclassification were: definite mesothelioma = 45 cases; probable = 7; possible = 31; inconclusive = 65; other tumors = 11. Thus, the number of mesotheliomas in Rio de Janeiro in 1979-2000 is estimated to have been 83. The analysis also suggests a problem with mortality codification in the State.

In plain English

This study estimated deaths from pleural mesothelioma (cancer of the lining around the lungs) in the State of Rio de Janeiro, Brazil, from 1979 to 2000. It also checked how reliable death certificates were. The authors reviewed 217 death certificates from 1979-1994 coded as pleural tumors, plus hospital records and tissue re-examined by pathologists. Pathologists also supplied cases up to 2000. Of the 217 certificates, 74 (34.1%) were judged wrongly coded. Tissue was re-examined in 51 cases, and 45 showed mesothelioma. Pathologists supplied 16 additional mesothelioma patients, none of whom appeared among the certificates collected. After reclassification, 45 cases were definite mesothelioma, 7 probable, 31 possible, 65 undetermined and 11 other tumors. Where a death certificate, medical record and tissue diagnosis were all available, certificates identified 11 of 31 tissue-confirmed mesotheliomas, a detection rate of 35.5%. Only eight of 73 hospital records stated asbestos exposure. The authors estimated 83 mesotheliomas over 1979-2000 and concluded this may be an underestimate because of coding problems. They noted lost records, that only five relatives agreed to cooperate, and that 40% of cases remained undetermined.

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: Retrospective population-based mortality study using death certificates, hospital records and blinded re-examination of tissue (histopathology with immunohistochemistry)
• Who was studied: Deaths coded as pleural tumors in the State of Rio de Janeiro, Brazil. There were 224 cases coded 1979-1994, of which 217 death certificates were recovered. Further cases up to 2000 were obtained from pathologists across the state.
• Exposure: Asbestos exposure was not measured in this study. Only eight hospital records stated that the patient had been exposed to asbestos.
• Main results:
  • Of the 217 recovered death certificates, 74 (34.1%) were considered wrongly coded as pleural tumors.
  • The most common wrong code among the 74 was ICD-9 199.1 (malignant neoplasm without specific site), with 45 cases (60.81%).
  • Pathologists provided material from 16 additional patients with mesothelioma, none of whom were among the death certificates collected.
  • Only 73 hospital records were located; 33 mentioned a diagnosis of mesothelioma.
  • Tissue was re-examined in 51 cases. In 45, a typical pattern for mesothelioma was seen and confirmed by immunohistochemistry.
  • Among confirmed cases, the most common type was epithelioid, in 27 (60%), followed by biphasic, in 8 (17.8%).
  • Among cases with death certificate, medical record and tissue data all available, 20 cases (58.8%) confirmed by tissue as mesothelioma had been reported on death certificates as other pleural tumors.
  • In the same group, 14 cases (41.2%) had been misdiagnosed in the medical records.
  • In the restricted group with death certificate, medical record and tissue data all available, death certificates detected 11 of 31 tissue-confirmed mesotheliomas (Table 4), a detection rate of 35.5%.
  • In the same restricted group, for medical records compared with tissue diagnosis, the detection rate was 54.8% and the confirmation rate was 100%.
  • Among 64 cases with both death certificates and medical records available, underreporting was evident in 17.2%.
  • Final classification: 45 definite mesothelioma, 7 probable, 31 possible, 65 undetermined and 11 other tumors.
  • Of the 45 definite mesotheliomas (28.3% of reclassified cases), 31 were male and 14 female; 15 were under 60 years and 30 over 60.
  • Among confirmed cases there was a 2:1 male to female ratio.
  • Counting confirmed, probable and possible cases together, the authors estimated 83 mesotheliomas in the State of Rio de Janeiro in 1979-2000.
• The authors' conclusion: The authors concluded that an estimated 83 mesotheliomas occurred in the State of Rio de Janeiro in 1979-2000, but that because of problems in the coding system this number may be an underestimate.
• Limitations the authors state:
  • In many hospitals, tissue material or records could not be found, causing a loss of information.
  • Letters were sent to 139 families, but only five people answered the invitation to be interviewed about the patients; the authors said only five relatives agreed to cooperate.
  • Occupational history was poorly recorded in the medical records.
  • Detection and confirmation rates were calculated only for cases with all data sources available, giving a smaller sample.
  • Despite all efforts, the diagnosis remained undetermined in 40% of cases.

Topics

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

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Death Certificate, Mesothelioma.

Related studies

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• Use of job-exposure matrix in an occupational analysis of lung and bladder cancers on the basis of death certificates — D. Coggon, B. Pannett, et al. (1984)
• Validation of death certificates in asbestos workers — M.L. Newhouse, J.C. Wagner (1969)
• A death-certificate case-control study of non-Hodgkin's lymphoma and occupation in men in North Carolina — M.C. Schumacher, E. Delzell (1988)
• Use of death certificates in epidemiological studies, including occupational hazards: variations in discordance of different asbestos-associated diseases on best evidence ascertainment — I.J. Selikoff, H. Seidman (1992)

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