Must countries shoulder the burden of mesothelioma to ban asbestos? A global assessment

Our plain-English summary of Must countries shoulder the burden of mesothelioma to ban asbestos? A global assessment, by O. Chimed-Ochir, E.M. Rath, T. Kubo, et al (BMJ Global Health, 2022).

The study

• Authors: O. Chimed-Ochir, E.M. Rath, T. Kubo, Y. Yumiya, R.T. Lin, S. Furuya, K. Brislane, S. Klebe, A.K. Nowak, S.K. Kang, K. Takahashi
• Journal: BMJ Global Health
• Published: 2022;7(12)
• Cited by: 6 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Introduction: Mesothelioma is a key asbestos-related disease (ARD) but can be difficult to diagnose. Countries presumably ban asbestos to reduce future ARD burdens, but it is unknown if countries ban asbestos as a consequence of ARD burdens. We assessed if and to what extent mesothelioma burden has an impact on a country banning asbestos and obtaining targets for preventative strategies.

Methods: We analysed the status of asbestos ban and mesothelioma burden during 1990-2019 in 198 countries. We assessed mesothelioma burden by age-adjusted mortality rates (MRs) estimated by the Global Burden of Disease Study (GBD) and mesothelioma identification by the WHO mortality database. For GBD-estimated mesothelioma MR, the pre-ban period in the asbestos-banned countries was compared with the 1990-2019 period in the not-banned countries. For mesothelioma identification, the 1990-2019 period was applied to both banned and not-banned countries.

Results: The association of mesothelioma MR with ban status increased as the ban year approached. Logistic regression analyses showed that the odds of a country banning asbestos increased 14.1-fold (95% CI 5.3 to 37.9) for mesothelioma identification combined with a 26% (12% to 42%) increase per unit increase of mesothelioma MR (one death per million per year) during the period 1-5 year before ban (model p<0.0001).

Conclusion: Mesothelioma burden had an impact on, and together with its identification, explained the banning of asbestos in many countries. Asbestos-banned countries likely learnt lessons from their historical policies of using asbestos because mesothelioma burden and identification follow historical asbestos use. Prevention targets for ARD elimination should combine asbestos ban with mesothelioma identification.

© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

In plain English

This study asked whether a country's mesothelioma burden was linked to its banning of asbestos. The authors used Global Burden of Disease estimates of mesothelioma death rates for 198 countries over 1990–2019. They also used whether each country reported mesothelioma deaths to the WHO mortality database (which they called 'identification') and a database of asbestos bans. Six countries that banned asbestos in or before 1990 were analysed separately. Of the 198 countries, 54 had banned asbestos. Before their bans, these countries averaged 5.14 estimated mesothelioma deaths per million per year, against 2.55 in countries without bans, and the gap widened nearer the ban year. In a combined model, countries reporting mesothelioma had 14.1 times the odds of a ban (95% CI 5.3 to 37.9). The odds also rose 26% (12% to 42%) per extra death per million per year in the five years before a ban (or before 2019). The authors concluded that mesothelioma burden and identification together explained bans in many countries. They noted their total reliance on error-prone estimates, and that cause and effect between identification and bans could not be discerned.

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: Global country-level analysis of published international data (Global Burden of Disease estimates, WHO mortality database, International Ban Asbestos Secretariat ban list), using chi-square tests, t-tests, analysis of variance and logistic regression
• Who was studied: 198 countries with a Global Burden of Disease estimated mesothelioma mortality rate available during 1990–2019. Six 'early-banned' countries (Austria, Denmark, Iceland, Norway, Sweden, Switzerland) were excluded from the main analysis and analysed separately.
• Exposure: No asbestos fiber types or individual exposures were studied. The explanatory factors were each country's estimated age-adjusted mesothelioma mortality rate (ICD-10 C45, all subcategories) before its ban (or over 1990–2019 for countries without a ban), and whether the country reported mesothelioma deaths to the WHO mortality database. The outcome was whether the country had banned asbestos.
• Main results:
  • Of 198 countries, 54 (27%) had banned asbestos and 144 (73%) had not.
  • 48 of the 54 banned countries (89%) and 54 of the 144 not-banned countries (38%) identified mesothelioma.
  • Average estimated mesothelioma mortality rate was 5.14 deaths per million per year in banned countries (pre-ban period) versus 2.55 in not-banned countries (p=0.0004).
  • In banned countries the average mortality rate rose, and the difference from not-banned countries widened, as the ban year approached.
  • In single-variable models, mesothelioma identification was associated with 13.3-fold odds of an asbestos ban (95% CI 5.4 to 33.2).
  • In single-variable models, each additional death per million per year raised the odds of a ban by 16% (4% to 29%) for more than 10 years before the ban, by 21% (9% to 34%) for 6–10 years before, and by 25% (13% to 39%) for 1–5 years before.
  • In the two-variable model, mesothelioma identification was associated with 14.1-fold odds of an asbestos ban (5.3 to 37.9).
  • In the same two-variable model, the odds of a ban rose 26% (12% to 42%) per additional death per million per year during the 1–5 years before the ban.
  • All six early-banned countries identified mesothelioma. Their 1990–1994 mortality rates were high relative to the 48 'banned and identified' countries.
  • There were exceptions. Canada, and to a lesser extent Turkey and South Africa, banned late despite relatively high mortality rates.
• The authors' conclusion: The authors concluded that mesothelioma burden, together with its identification, explained asbestos bans in many countries. They called for prevention strategies that combine banning asbestos with identifying mesothelioma.
• Limitations the authors state:
  • The study depended entirely on Global Burden of Disease estimates, which are prone to error, particularly for developing countries.
  • The approach may be oversimplified and may have overlooked other factors, such as stakeholders' knowledge, national economic status and political motives.
  • The six early-banned countries could not be analysed directly.
  • Mesothelioma identification was not limited to the pre-ban period, because mesothelioma first entered the WHO mortality database in 1994.
  • Cause and effect between mesothelioma identification and asbestos bans could not be determined.

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.

Related studies

• Global burden of tracheal, bronchus, and lung cancer attributable to occupational carcinogens in 204 countries and territories, from 1990 to 2019: results from the global burden of disease study 2019 — Y. Zhang, M. Mi, et al. (2023)
• Global burden of mesothelioma attributable to occupational asbestos exposure in 204 countries and territories: 1990-2019 — Z. Chen, Y. Cai, et al. (2024)
• Evolving trends in lung cancer risk factors in the ten most populous countries: an analysis of data from the 2019 Global Burden of Disease Study — C.T. Jani, S.A. Kareff, et al. (2025)
• Global and regional burden of disease and injury in 2016 arising from occupational exposures: a systematic analysis for the Global Burden of Disease Study 2016 — GBD 2016 Occupational Risk Factors Collaborators (2020)
• The global burden and associated factors of ovarian cancer in 1990-2019: findings from the Global Burden of Disease Study 2019 — S. Zhang, C. Cheng, et al. (2022)
• Burden of ovarian cancer in China from 1990 to 2030: A systematic analysis and comparison with the global level — Y. Wang, Z. Wang, et al. (2023)

Browse return to medical research.