Occupational Burden of Asbestos-Related Diseases in Korea, 1998-2013: Asbestosis, Mesothelioma, Lung Cancer, Laryngeal Cancer, and Ovarian Cancer

Our plain-English summary of Occupational Burden of Asbestos-Related Diseases in Korea, 1998-2013: Asbestosis, Mesothelioma, Lung Cancer, Laryngeal Cancer, and Ovarian Cancer, by D.M. Kang, J.E. Kim, Y.K. Kim, et al (Journal of Korean Medical Science, 2018).

The study

• Authors: D.M. Kang, J.E. Kim, Y.K. Kim, H.H. Lee, S.Y. Kim
• Journal: Journal of Korean Medical Science
• Published: 2018;33(35):e226
• Cited by: 28 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Asbestos exposure causes asbestos-related diseases (ARDs) including asbestosis, malignant mesothelioma, lung cancer, laryngeal cancer, and ovarian cancer. Although Korea used substantial amounts of asbestos in the past, no study has focused on its occupational burden of disease (OBD). Therefore, this study aimed to determine the OBDs of ARDs in Korea.

Methods: The CARcinogen Exposure (CAREX) database was used to determine the proportion of exposed population. Relative risks for lung cancer, laryngeal cancer, and ovarian cancer were used to determine the population-attributable fraction. Data for deaths caused by ARDs during 1998-2013 were obtained from the World Health Organization mortality database. The potential years of life lost (PYLL) and annual average PYLL (APYLL) indicated OBDs.

Results: In Korea, the number of ARD-attributable deaths and PYLL due to all ARDs during 1998-2013 were 4,492 and 71,763.7, respectively. The number of attributable deaths and PYLL due to asbestosis, malignant mesothelioma, lung cancer, laryngeal cancer, and ovarian cancer were 37 and 554.2, 808 and 15,877.0, 3,256 and 47,375.9, 120 and 1,605.5, and 271 and 6,331.1, respectively; additionally, the APYLL were 15.0, 19.7, 14.6, 13.4, and 23.4, respectively, and the average age at death was 70.4, 62.6, 69.1, 69.9, and 61.8, respectively. Our study showed that although the use of asbestos has ceased in Korea, the incidence of ARDs tends to increase.

Conclusion: Therefore, efforts to reduce future OBDs of ARDs, including early detection and proper management of ARDs, are needed in Korea.

In plain English

This study estimated how many deaths and years of life lost in Korea from 1998 to 2013 could be attributed to asbestos exposure at work. The authors estimated the number of exposed workers by applying CAREX industry exposure proportions to Korean workforce data for 1991 to 2003. They took death counts from the World Health Organization mortality database. All asbestosis and malignant mesothelioma deaths were counted as caused by asbestos. For lung, laryngeal and ovarian cancer, a share of deaths was assigned using relative risks from earlier studies. They estimated 4,492 attributable deaths and 71,763.7 potential years of life lost. By disease, there were 3,256 lung cancer deaths, 808 mesothelioma deaths, 271 ovarian cancer deaths, 120 laryngeal cancer deaths and 37 asbestosis deaths. Average age at death ranged from 61.8 for ovarian cancer to 70.4 for asbestosis. Mesothelioma deaths were much lower than in other countries, which the authors linked to low crocidolite use or latency. Lower asbestosis figures were linked to possible under-diagnosis. The authors said their methods were indirect and might under- or overestimate the burden. They concluded that early detection and proper management are needed in Korea.

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: National occupational burden-of-disease estimate. It combined exposure proportions from the CAREX database, population-attributable fractions and WHO mortality data to calculate attributable deaths and potential years of life lost. It also included a literature comparison with other countries.
• Who was studied: Deaths in Korea from asbestosis, malignant mesothelioma, lung cancer, laryngeal cancer and ovarian cancer during 1998 to 2013 (16 years), from the WHO mortality database. The exposed working population was estimated for 1991 to 2003.
• Exposure: Occupational asbestos exposure, with no fiber type specified. The number of exposed workers was estimated by applying CAREX exposure proportions for each economic sector to Korean workforce data, with a turnover factor of 4. Asbestosis and malignant mesothelioma were treated as 100% attributable to asbestos. Relative risks were taken from previous studies: 1.81 for lung cancer (Moon et al.), 1.44 for laryngeal cancer (Institute of Medicine) and 1.77 for ovarian cancer (Camargo et al.).
• Main results:
  • Across all five diseases in Korea during 1998 to 2013, there were 4,492 asbestos-attributable deaths and 71,763.7 potential years of life lost.
  • Attributable deaths and potential years of life lost by disease: asbestosis 37 and 554.2; malignant mesothelioma 808 and 15,877.0 (15,897.00 in Table 4); lung cancer 3,256 and 47,375.9; laryngeal cancer 120 and 1,605.5; ovarian cancer 271 and 6,331.1.
  • Share of all attributable deaths and of years of life lost, respectively: asbestosis 0.8% and 0.8%; malignant mesothelioma 18.0% and 22.0%; lung cancer 72.5% and 66.0%; laryngeal cancer 2.7% and 2.2%; ovarian cancer 6.0% and 8.8%.
  • Average years of life lost per death: asbestosis 15.0, malignant mesothelioma 19.7, lung cancer 14.6, laryngeal cancer 13.4, ovarian cancer 23.4.
  • Average age at death: asbestosis 70.4, malignant mesothelioma 62.6, lung cancer 69.1, laryngeal cancer 69.9, ovarian cancer 61.8.
  • Proportion of women among attributable deaths: asbestosis 43.2%, malignant mesothelioma 31.7%, lung cancer 26.3%, laryngeal cancer 11.7%, ovarian cancer 100%.
  • The estimated occupationally exposed population, using a turnover factor of 4, was lowest at 659,193 in 1999. The text gives a maximum of 745,914 in 2007, a figure that does not appear in Table 3.
  • Mean deaths and years of life lost from malignant mesothelioma in Korea were much lower than those reported worldwide, in Europe, in the USA and in Japan. The authors suggested this could reflect low use of crocidolite and sprayed asbestos in Korea, or a latency lag.
  • The burden from asbestosis in Korea tended to be lower than in other countries. The authors suggested this was possibly due to under-diagnosis.
• The authors' conclusion: The authors concluded that, given past asbestos use, asbestos-related diseases are expected to keep increasing in Korea. They said efforts including early detection and proper management are needed to reduce the years of life lost.
• Limitations the authors state:
  • Exposure estimates relied on European CAREX proportions. Industry structure and exposure patterns in Korea may differ from Europe, so the exposed population may be under- or overestimated.
  • The turnover factor of 4 could under- or overestimate the exposed population.
  • No relative risks for laryngeal or ovarian cancer based on the Korean population were available.
  • Estimating attributable fractions from relative risks is an indirect method and might cause under- or overestimation.
  • The WHO mortality data might undercount deaths from asbestosis and malignant mesothelioma.
  • The study did not cover the burden from environmental (non-occupational) asbestos exposure.

Topics

Medical terms in this study, explained in our Lexicon: Mesothelioma, Lung Cancer, Laryngeal Cancer, Ovarian Cancer, Asbestos Exposure, Malignant Mesothelioma, Relative Risk.

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