Predictions of Mortality from Pleural Mesothelioma in Italy After the Ban of Asbestos Use

Our plain-English summary of Predictions of Mortality from Pleural Mesothelioma in Italy After the Ban of Asbestos Use, by E. Oddone, J. Bollon, C.R. Nava, et al (International Journal of Environmental Research and Public Health, 2020).

The study

• Authors: E. Oddone, J. Bollon, C.R. Nava, M. Bugani, D. Consonni, A. Marinaccio, C. Magnani, F. Barone-Adesi
• Journal: International Journal of Environmental Research and Public Health
• Published: 2020;17(2)
• Cited by: 27 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Even if the epidemic of malignant pleural mesothelioma (MPM) is still far from being over worldwide, the health effects of regulations banning asbestos can be evaluated in the countries that implemented them early. Estimates of MPM future burden can be useful to inform and support the implementation of anti-asbestos health policies all around the world. With this aim we described the trends of MPM deaths in Italy (1970-2014) and predicted the future number of cases in both sexes (2015-2039), with consideration of the national asbestos ban that was issued in 1992. The Italian National Statistical Institute (ISTAT) provided MPM mortality figures. Cases ranging from 25 to 89 years of age were included in the analysis. For each five-year period from 1970 to 2014, mortality rates were calculated and age-period-cohort Poisson models were used to predict future burden of MPM cases until 2039. During the period 1970-2014 a total number of 28,907 MPM deaths were observed. MPM deaths increased constantly over the study period, ranging from 1356 cases in 1970-1974 to 5844 cases in 2010-2014. The peak of MPM cases is expected to be reached in the period 2020-2024 (about 7000 cases). The decrease will be slow: about 26,000 MPM cases are expected to occur in Italy during the next 20 years (2020-2039). The MPM epidemic in Italy is far from being concluded despite the national ban implemented in 1992, and the peak is expected in 2020-2024, in both sexes. Our results are consistent with international literature.

In plain English

This study used Italian national death statistics on malignant pleural mesothelioma (MPM) among people aged 25 to 89 from 1970 to 2014. It used age–period–cohort statistical models to predict deaths for 2015–2039. Italy had no specific death code for MPM before 2003, so deaths for 1970–2002 were estimated from pleural cancer deaths using a correction factor. In all, 28,907 MPM deaths were observed: 20,245 in men and 8662 in women. From 1970–1974 to 2010–2014, deaths per five-year period rose from 856 to 4275 in men and from 500 to 1569 in women. Death rates reached 3.99 per 100,000 person-years in men and 1.34 in women. The models predicted a peak in 2020–2024 of about 5200 deaths in men and 1800 in women, followed by a slow decline. About 19,500 deaths in men and 6700 in women were predicted for 2020–2039. The authors concluded that the epidemic in Italy is far from over despite the 1992 asbestos ban. They noted that their models may not fully capture the ban's effects and that national death data probably undercount mesothelioma.

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: Analysis of national mortality statistics, with observed death rates by age, period and birth cohort and Poisson age–period–cohort models used to predict deaths for 2015–2039. Deaths for 1970–2002 were estimated by applying a correction factor to pleural cancer deaths, because a specific MPM death code was only available from 2003.
• Who was studied: Deaths from malignant pleural mesothelioma among men and women aged 25 to 89 in Italy, 1970–2014, from data of the Italian National Statistical Institute (ISTAT)
• Exposure: Asbestos exposure in general. No fiber types or individual exposures were measured. Trends were considered in relation to Italy's 1992 national ban on asbestos extraction, use and commercialization (Law 257/92).
• Main results:
  • 28,907 MPM deaths were observed in Italy in 1970–2014: 20,245 (70.0%) among men and 8662 (30.0%) among women
  • Among men, deaths per five-year period rose from 856 in 1970–1974 to 4275 in 2010–2014
  • Among women, deaths per five-year period rose from 500 in 1970–1974 to 1569 in 2010–2014
  • The men-to-women ratio of deaths rose from 1.73 in 1970–1974 to 2.72 in 2010–2014
  • Death rates rose over time in both sexes, reaching a maximum of 3.99 per 100,000 person-years in men and 1.34 per 100,000 person-years in women
  • In 1970–1999 the average yearly increase in rates was about 4.5% in men and 1.2% in women
  • In 2000–2014 the average yearly increase in rates was 10.0% in men and 2.7% in women
  • The age–period–cohort model fit the data best; the age–cohort model gave almost identical predictions
  • Predicted peak in 2020–2024 for both sexes, with about 5200 deaths among men and 1800 among women
  • About 19,500 deaths among men and 6700 among women were predicted for 2020–2039
  • The predicted decline was slow: predicted deaths in 2035–2039 were about 80% of those at the peak
  • The predicted men-to-women ratio stayed fairly constant from 2015 to 2039, ranging between 2.89 and 2.98
• The authors' conclusion: The authors concluded that, consistent with the literature, the MPM epidemic in Italy is still far from over despite the national ban of 1992.
• Limitations the authors state:
  • The prediction models may not completely capture the effects of the 1992 asbestos ban
  • Changes in the age structure of the population can substantially affect the predictions
  • The predictions do not assume any future improvement in MPM prognosis; effective new treatments could reduce future deaths
  • National mortality data probably underestimate the actual number of mesotheliomas (misdiagnosis, non-diagnosis or lack of reporting), according to other studies the authors cite

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.

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• Effect of Asbestos Consumption on Malignant Pleural Mesothelioma in Italy: Forecasts of Mortality up to 2040 — E. Oddone, J. Bollon, et al. (2021)
• Predictions of mortality from pleural mesothelioma in Italy: a model based on asbestos consumption figures supports results from age-period-cohort models — A. Marinaccio, F. Montanaro, et al. (2005)
• Cumulative asbestos exposure and mortality from asbestos related diseases in a pooled analysis of 21 asbestos cement cohorts in Italy — F. Luberto, D. Ferrante, et al. (2019)
• Burden of Mortality from Asbestos-Related Diseases in Italy — L. Fazzo, A. Binazzi, et al. (2021)
• Past trends and future prediction of mesothelioma incidence in an industrialized area of Italy, the Veneto Region — P. Girardi, V. Bressan, et al. (2014)

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