Regional variations in German mesothelioma mortality rates: 2000–2010

Our plain-English summary of Regional variations in German mesothelioma mortality rates: 2000–2010, by S.J. Schonfeld, V. McCormack, M.J. Rutherford, et al (Cancer Causes & Control, 2014).

The study

• Authors: S.J. Schonfeld, V. McCormack, M.J. Rutherford, J. Schüz
• Journal: Cancer Causes & Control
• Published: 2014;25(5):615-24
• Cited by: 23 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Purpose: Germany has one of the highest age-adjusted mesothelioma mortality rates worldwide. As mesothelioma occurs ≥ 30 years after asbestos exposure, contemporary rates likely reflect exposures in the 1960-1970s. During this period, political division between West and East Germany led to differences regarding the import and consumption of asbestos. It is unclear whether mesothelioma rates also differ between these formerly separate countries which are now served by similar health and mortality reporting systems, thereby facilitating regional comparisons.

Methods: We examined regional, temporal, and sex variations in mesothelioma mortality rates in Germany in 2000-2010, collapsing the federal states into West Germany, East Germany, and Berlin. We calculated truncated (≥ 40 years) age-standardized mesothelioma mortality rates (ASRs(40+)) per 100,000 person-years, estimated sex-stratified mortality rate ratios (MRRs) (95 % confidence intervals (CIs)), adjusted for age and calendar year from Poisson models, and fitted age-period-cohort models.

Results: There were 12,854 mesothelioma deaths at ages ≥ 40 years in Germany during 2000-2010. ASRs(40+) were higher in West (males 4.4; females 0.8) than East (males 1.7; females 0.6) Germany. MRRs for West versus East Germany were 2.68 (95 % CI 2.48-2.88) among males and 1.42 (95 % CI 1.27-1.59) among females. In both regions, mortality rates increased for birth cohorts until the mid 1940s and subsequently declined. The country's peak mesothelioma burden is predicted to occur by 2020.

Conclusions: Geographical differences in mesothelioma mortality rates are consistent with heterogeneous historical asbestos exposures. Differences may exist for other asbestos-related cancers and should be investigated in analytic studies with individual asbestos exposure information.

In plain English

This study used national death records to compare mesothelioma death rates across regions of Germany from 2000 to 2010, among people aged 40 and older. There were 10,069 mesothelioma deaths in men and 2,785 in women. Most were pleural mesothelioma: 90.3% of deaths in men and 82.2% in women. Age-standardized death rates per 100,000 person-years were highest in former West Germany (men 4.4, women 0.8), in between in Berlin (men 2.7, women 0.7) and lowest in former East Germany (men 1.7, women 0.6). Compared with East Germany, the rate ratio for West Germany was 2.68 (95% CI 2.48–2.88) in men and 1.42 (95% CI 1.27–1.59) in women. The highest rates were in Bremen, followed by Hamburg. In West Germany, men's rates rose for those born up to the early-to-mid 1940s and fell for later births. Similar declines in East Germany were not statistically significant. A model for men predicted the total number of deaths would peak by 2020. The study had no information on individual asbestos exposure. The authors concluded that the regional patterns suggest asbestos exposures differed between the formerly divided regions.

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: Population-level (ecological) analysis of national mortality statistics, including age-period-cohort modelling and projections; no individual-level data
• Who was studied: All mesothelioma deaths at ages 40 and over recorded in Germany, 2000–2010: 10,069 men and 2,785 women (12,854 total). Federal states were grouped into former West Germany, former East Germany and Berlin.
• Exposure: No individual asbestos exposure was measured. Region of death (former West versus East Germany) was compared, and the authors interpreted it in light of differences in historical asbestos use.
• Main results:
  • Pleural mesothelioma made up 90.3% of deaths in men and 82.2% in women. Peritoneal mesothelioma made up 2.4% in men and 6.4% in women.
  • Age-standardized rates per 100,000 person-years (ages 40 and over) were highest in West Germany (males 4.4; females 0.8), intermediate in Berlin (males 2.7; females 0.7) and lowest in East Germany (males 1.7; females 0.6).
  • Among males, the mortality rate ratio versus East Germany was 2.68 (95% CI 2.48–2.88) for West Germany and 1.64 (95% CI 1.42–1.89) for Berlin.
  • Among females, the mortality rate ratio versus East Germany was 1.42 (95% CI 1.27–1.59) for West Germany and 1.12 (95% CI 0.89–1.41) for Berlin.
  • The highest rates in both males and females were in Bremen, followed by Hamburg.
  • The male-to-female ratio of rates was highest in the North of West Germany (5.9) and lowest in East Germany (2.9).
  • Among West German males, rates increased with birth cohort until the early to mid 1940s and declined for later cohorts. Similar declines in East Germany were not statistically significant in males or females.
  • Among West German men under 65, rates declined by 5.5% per year (95% CI -6.8 to -4.3%).
  • Among West German men 65 and over, rates rose by 2.9% per year (95% CI 2.1 to 3.7%).
  • Projections for males predicted the total mesothelioma burden would peak in both East and West Germany by 2020.
• The authors' conclusion: The authors concluded that distinct geographical patterns of mesothelioma mortality exist within Germany, especially between East and West. They said this suggests asbestos exposures differed between the formerly divided regions and that differences likely exist for other asbestos-related cancers.
• Limitations the authors state:
  • There were no individual-level data, so it was not known whether the place of past asbestos exposure was the same as the place where the death was registered.
  • Migration after reunification could have reduced the differences between the regions.
  • The short observation period (2000–2010) calls for caution in interpreting the projections.
  • Small numbers of deaths among East German males and among females made it hard to compare age, period and cohort effects between groups.
  • The data could not assess the influence of factors such as fiber types used or regional differences in competing causes of death.

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, Asbestos Exposure, rate ratio, confidence interval.

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