Predicting the mortality from asbestos-related diseases based on the amount of asbestos used and the effects of slate buildings in Korea

Our plain-English summary of Predicting the mortality from asbestos-related diseases based on the amount of asbestos used and the effects of slate buildings in Korea, by S.Y. Kim, Y.C. Kim, Y. Kim, et al (The Science of the Total Environment, 2016).

The study

• Authors: S.Y. Kim, Y.C. Kim, Y. Kim, W.H. Hong
• Journal: The Science of the Total Environment
• Published: 2016;542(Pt A):1-11
• Cited by: 35 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Asbestos has been used since ancient times, owing to its heat-resistant, rot-proof, and insulating qualities, and its usage rapidly increased after the industrial revolution. In Korea, all slates were previously manufactured in a mixture of about 90% cement and 10% chrysotile (white asbestos). This study used a Generalized Poisson regression (GPR) model after creating databases of the mortality from asbestos-related diseases and of the amount of asbestos used in Korea as a means to predict the future mortality of asbestos-related diseases and mesothelioma in Korea. Moreover, to predict the future mortality according to the effects of slate buildings, a comparative analysis based on the result of the GPR model was conducted after creating databases of the amount of asbestos used in Korea and of the amount of asbestos used in making slates. We predicted the mortality from asbestos-related diseases by year, from 2014 to 2036, according to the amount of asbestos used. As a result, it was predicted that a total of 1942 people (maximum, 3476) will die by 2036. Moreover, based on the comparative analysis according to the influence index, it was predicted that a maximum of 555 people will die from asbestos-related diseases by 2031 as a result of the effects of asbestos-containing slate buildings, and the mortality was predicted to peak in 2021, with 53 cases. Although mesothelioma and pulmonary asbestosis were considered as asbestos-related diseases, these are not the only two diseases caused by asbestos. However the results of this study are highly important and relevant, as, for the first time in Korea, the future mortality from asbestos-related diseases was predicted. These findings are expected to contribute greatly to the Korean government's policies related to the compensation for asbestos victims.

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In plain English

This was a statistical forecasting study of deaths from asbestos-related diseases in Korea. The authors combined national death records for mesothelioma and pulmonary asbestosis from 1997 to 2013 (877 deaths: 842 mesothelioma, 35 asbestosis) with customs records of asbestos imports and production (1,844,460 metric tons). They then fitted a generalized Poisson regression model. The selected model linked deaths in each year to asbestos use 33 years earlier and in the four years before that. It predicted about 1942 deaths from these diseases from 2014 to 2036 (upper estimate 3476), with yearly deaths peaking in 2020 at about 139 (upper 95% interval limit 284). Mesothelioma deaths over that period were predicted at about 1869. Using the national building register, the authors estimated that slate roofs contained 157,649 metric tons of asbestos. The article describes Korean slates as containing about 10% chrysotile. The authors assumed a range of values for the share of deaths caused by slate buildings, because no study existed to set it. Under the highest assumed value, they predicted 555 slate-related deaths by 2031, peaking in 2021 at about 53. They noted that lung cancer was excluded, so actual deaths may be higher, and that the data period was short.

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: Statistical projection (modeling) study using national death, customs and building-register data, analyzed with a generalized Poisson regression model with distributed lags, plus a comparative analysis using assumed 'influence index' values for slate buildings
• Who was studied: All deaths in Korea recorded as mesothelioma (C45) or pulmonary asbestosis (J61) from 1997 to 2013 (877 deaths), linked to national asbestos use from 1941 to 2008; also all buildings in the Korean building register (6,671,507), of which 956,453 had slate roofs
• Exposure: Total national asbestos use (imports from 1976 to 2008 plus domestic output from 1941 to 1990, 1,844,460 metric tons) and asbestos in slate roofing, which the article describes as about 90% cement and 10% chrysotile (white asbestos)
• Main results:
  • Of the observed deaths from 1997 to 2013, 842 were from mesothelioma and 35 from pulmonary asbestosis; mesothelioma deaths were 24.05 times those from asbestosis
  • Among the observed deaths, the highest yearly number was in 2012 (106), and deaths among men were about 17.72 times those among women
  • The model selected as optimal used Δ=33 and k=4. Its lag terms (Table 5, from xt-Δ to xt-Δ-4) cover asbestos use 33 years before each year's deaths and in the four years before that.
  • Predicted deaths from asbestos-related diseases (mesothelioma plus pulmonary asbestosis) in Korea from 2014 to 2036: about 1942 in total, with an upper estimate of 3476
  • Predicted yearly deaths from asbestos-related diseases were expected to peak in 2020 at about 139. The upper limit of the 95% interval for 2020 was 284.
  • Predicted mesothelioma deaths from 2014 to 2036: about 1869 in total, with a peak in 2020 of about 136 (men about 85, women about 50)
  • Asbestos contained in all slate buildings in Korea was estimated at 157,649 metric tons
  • The authors used assumed influence index values from 5 to 50. Under the highest value, they predicted 555 deaths from asbestos-related diseases due to slate buildings by 2031, peaking in 2021 at about 53.
• The authors' conclusion: The authors described this as the first prediction of future asbestos-related disease mortality in Korea. They expected the results to contribute to Korean government policies on compensation for asbestos victims.
• Limitations the authors state:
  • Only mesothelioma and pulmonary asbestosis were counted. Lung cancer was excluded because asbestos could not be identified as its cause, so the authors expected more deaths than predicted.
  • Death statistics have only been kept since 1997, a short period compared with the period of asbestos use
  • The death records cannot distinguish cases where the cause of death was not asbestos
  • Asbestos production and import records were considered uncertain and covered a relatively short period
  • The building register may contain administrative errors, and roof replacement dates were not recorded
  • The share of deaths due to slate buildings (influence index) could not be estimated, so the authors used assumed values

Topics

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

Medical terms in this study, explained in our Lexicon: Chrysotile, Mesothelioma, Asbestosis.

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