Pleural mesothelioma in Poland: Spatial analysis of malignant mesothelioma prevalence in the period 1999-2013

Our plain-English summary of Pleural mesothelioma in Poland: Spatial analysis of malignant mesothelioma prevalence in the period 1999-2013, by M. Krówczyńska, E. Wilk, P. Pabjanek, et al (Geospatial Health, 2018).

The study

• Authors: M. Krówczyńska, E. Wilk, P. Pabjanek, G. Olędzka
• Journal: Geospatial Health
• Published: 2018;13(2)
• Cited by: 3 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Malignant mesothelioma (MM), a rare and very deadly tumour, can be due to asbestos exposure. To better understand the cause of incidence of MM, spatial autocorrelation analysis with reference to the quantity of asbestos-cement products in use and the localisation of former asbestos manufacturing plants was applied. Geostatistical analysis shows that strong spatial clustering of MM incidence (referring to the general population as well as females and males separately) during the period 1999-2013 in the administrative units of Poland (provinces and counties). Incidence hotspots were found to be concentrated primarily in southern Poland but also seen in the county of Szczecin, which stands out in local autocorrelation analysis in north-western Poland. High incidence rates were discovered, in particular with reference to counties around former plants manufacturing asbestos-containing products, mainly asbestos-cement manufacturers. The highest frequency of MM incidence rate was found in within a 55 km radius of plants in or near the towns Trzebinia, Ogrodzieniec and Szczucin in the South, where asbestos-cement products had been manufactured for close to 40 years. Areas with significantly high incidence rates were also discovered in the provinces of Śląskie, Małopolskie and Świętokrzyskie in southern Poland.

In plain English

This study mapped malignant mesothelioma cases recorded in Poland's National Cancer Register from 1999 to 2013 under disease code C45. Cases were grouped by county (380 counties) and by sex. The authors used spatial statistics to find clusters and compared them with the locations of former asbestos manufacturing plants and the amount of asbestos-containing products still in use. They used crude rates because the data were not broken down by age. Cases clustered significantly, most strongly among men, with hotspots in southern Poland. Forty-seven counties had higher-than-normal rates in the general population, 53 for men and 15 for women. Dąbrowski County had the highest rate in every group. The highest rates were reported near most former asbestos-cement plants, though not Trzemeszno; the article's count of these plants is inconsistent. The amount of asbestos-containing products in use per inhabitant was negatively correlated with mesothelioma rates (minus 0.2 to minus 0.25). The authors concluded that there is a relationship between former plant locations and areas of increased risk. They noted that this kind of analysis does not establish cause and effect, and they called for research that separates occupational cases from other cases.

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: Geographic (ecological) spatial analysis of registry data, using global and local spatial autocorrelation and hotspot statistics (Moran's I, Getis-Ord G, Getis-Ord Gi, Local Moran's I) with a 55 km distance threshold
• Who was studied: All malignant mesothelioma cases registered under ICD-10 code C45 in Poland's National Cancer Register, 1999-2013, classified by county (380 counties) and sex; analysed for the general population, males and females
• Exposure: No individual exposure data. Area-level measures were used: the quantity of asbestos-containing products still in use (from the GeoAzbest database, mapped as asbestos-cement products per 100,000 inhabitants) and the locations of former asbestos manufacturing plants (mainly asbestos-cement, also paper, textiles and rubber), with 55 km buffers around plants
• Main results:
  • Mesothelioma cases rose over the period. The highest yearly count was in 2013: 210 cases among males and 116 among females.
  • Global spatial autocorrelation was positive and statistically significant in all groups. Moran's I was 0.1447 for the general population, 0.0846 for females and 0.1964 for males, with P-values printed as 0.000000. The highest level was for males.
  • Hotspot analysis identified 47 counties with a higher-than-normal mesothelioma incidence rate in the general population: 3 in Podkarpackie, 5 in Świętokrzyskie, 10 in Małopolskie and 29 in Śląskie.
  • Hotspot analysis identified 15 counties for female cases and 53 counties for male cases (2 in Opolskie, 3 in Podkarpackie, 4 in Świętokrzyskie, 13 in Małopolskie and 31 in Śląskie).
  • A coldspot (low-rate cluster) was found for males in 7 counties in Wielkopolskie, western Poland.
  • Within the buffers around asbestos manufacturing plants, 44 of 49 counties were designated hotspot (High-High) areas, and 45 of 47 counties were designated hotspot areas, both at a 99% confidence level.
  • Dąbrowski County had the highest mesothelioma incidence rate in all groups: 184 for the general population, 169 for women and 200 for men (units not stated). The authors described this as almost five times higher than in other counties.
  • The authors reported the highest incidence rates near most former asbestos-cement manufacturing plants, but no such correlation for the plant at Trzemeszno. The count is inconsistent in the article: it says seven out of eight plants, names eight plants, and then gives Trzemeszno as a separate exception.
  • The Spearman rank correlation between the quantity of asbestos-containing products in use per inhabitant and the mesothelioma incidence rate ranged from -0.2 to -0.25 across groups, which the authors described as a negative correlation.
  • The correlation between the crude female and crude male incidence rates was 0.83.
• The authors' conclusion: The authors concluded that there is a relationship between the locations of former asbestos manufacturing plants and the areas designated as having increased mesothelioma risk. They suggested that air pollution in the same southern provinces may also affect incidence, and called for further research, including spatial regression modelling.
• Limitations the authors state:
  • Crude (raw) rates were used because mesothelioma case data by age were not available, so rates were not age-adjusted.
  • The authors state that this type of incidence analysis does not support cause-and-effect conclusions.
  • Occupational and other cases were not separated, so the effect of environmental exposure on case numbers could not be determined.

Topics

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

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Malignant Mesothelioma, Asbestos Exposure, Asbestos-Cement, Incidence.

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• Cancer survival and prevalence in Australia: period estimates from 1982 to 2010 — Australian Institute of Health and Welfare (2013)
• Environmental and Occupational Exposure to Asbestos as a Result of Consumption and Use in Poland — M. Krówczyńska, E. Wilk (2019)
• Reply to Comment on Małgorzata Krówczyńska and Ewa Wilk. Environmental and Occupational Exposure to Asbestos as a Result of Consumption and Use in Poland. Int. J. Environ. Res. Public Health 2019, 16, 2611 — M. Krówczyńska, E. Wilk (2020)

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