Sex-Specific Mortality from Asbestos-Related Diseases, Lung and Ovarian Cancer in Municipalities with High Asbestos Consumption, Brazil, 2000-2017

Our plain-English summary of Sex-Specific Mortality from Asbestos-Related Diseases, Lung and Ovarian Cancer in Municipalities with High Asbestos Consumption, Brazil, 2000-2017, by C.A. Saito, M.A. Bussacos, L. Salvi, et al (International Journal of Environmental Research and Public Health, 2022).

The study

• Authors: C.A. Saito, M.A. Bussacos, L. Salvi, C. Mensi, D. Consonni, F.T. Fernandes, F. Campos, F. Cavalcante, E. Algranti
• Journal: International Journal of Environmental Research and Public Health
• Published: 2022;19(6)
• Cited by: 14 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

The aim of this study is to compare the mortality rates for typical asbestos-related diseases (ARD-T: mesothelioma, asbestosis, and pleural plaques) and for lung and ovarian cancer in Brazilian municipalities where asbestos mines and asbestos-cement plants had been operating (areas with high asbestos consumption, H-ASB) compared with in other municipalities. The death records for adults aged 30+ years were retrieved from multiple health information systems. In the 2000-2017 time period, age-standardized mortality rates (standard: Brazil 2010) and standardized rate ratios (SRR; H-ASB vs. others) were estimated. The SRRs for ARD-T were 2.56 for men (257 deaths in H-ASB municipalities) and 1.19 for women (136 deaths). For lung cancer, the SRRs were 1.33 for men (32,604 deaths) and 1.19 for women (20,735 deaths). The SRR for ovarian cancer was 1.34 (8446 deaths). Except for ARD-T and lung cancer in women, the SRRs were higher in municipalities that began using asbestos before 1970 than in municipalities that began utilizing asbestos from 1970 onwards. In conclusion, the mortality rates for ARD-T, and lung and ovarian cancer in municipalities with a history of asbestos mining and asbestos-cement production exceed those of the whole country. Caution is needed when interpreting the results of this ecological study. Analytical studies are necessary to document the impact of asbestos exposure on health, particularly in the future given the long latency of asbestos-related cancers.

In plain English

This ecological study compared death rates in Brazil from 2000 to 2017 among adults aged 30 and over. It grouped 29 municipalities with high asbestos consumption (five with asbestos mines and 24 with asbestos-cement plants) and compared them with all other municipalities. Death records were gathered and linked from several health information systems. Exposure was assigned only by where people lived. In the high-consumption municipalities, men had a standardized rate ratio of 2.56 (95% CI 2.27 to 2.88; 357 deaths) for typical asbestos-related diseases (mesothelioma, asbestosis and pleural plaques combined), and 1.33 for lung cancer. For women, the ratio for the typical diseases was 1.19, with a 95% CI of 0.99 to 1.43, which dipped below equal rates. For women it was 1.19 for lung cancer and 1.34 for ovarian cancer. The authors concluded that there was excess mortality from these diseases but urged caution because the study was ecological. The lung and ovarian cancer analyses could not account for confounders, patients may have moved to larger cities for care, and diagnoses outside a specialized outpatient repository could not be checked. They called for analytical studies.

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: Retrospective ecological study of death records linked from several health information systems, comparing age-standardized mortality rates between areas
• Who was studied: Deaths among adults aged 30 years or over in Brazil, 2000 to 2017. The comparison was between 29 high-asbestos-consumption municipalities (5 with asbestos mining, 24 with asbestos-cement plants; 9,725,764 inhabitants, 10.4% of the Brazilian population in 2010) and the remaining Brazilian municipalities. In the high-consumption municipalities there were 493 deaths from typical asbestos-related diseases (357 men, 136 women), 32,604 lung cancer deaths in men, 20,735 lung cancer deaths in women, and 8,446 ovarian cancer deaths.
• Exposure: Residence in a municipality that had asbestos mining or asbestos-cement plants. No individual exposure data were collected. The article states chrysotile was the predominant fiber used in Brazil.
• Main results:
  • Men in the high-consumption municipalities, typical asbestos-related diseases pooled: SRR 2.56 (95% CI 2.27 to 2.88), 357 deaths, compared with the rest of the country
  • Men in the high-consumption municipalities: SRRs for the individual typical diseases ranged from 1.70 (mesothelioma, 95% CI 1.45 to 1.99) to 6.35 (asbestosis, 95% CI 4.86 to 8.28); pleural plaques SRR 5.06 (95% CI 3.69 to 6.89); lung cancer SRR 1.33 (95% CI 1.31 to 1.34)
  • Women in the high-consumption municipalities: typical asbestos-related diseases pooled SRR 1.19 (95% CI 0.99 to 1.43; 136 deaths); mesothelioma 1.17 (0.95 to 1.43); asbestosis 1.86 (0.96 to 3.39); pleural plaques 0.86 (0.35 to 1.79). The lower limit of each of these confidence intervals fell below the value that would mean equal death rates.
  • Women in the high-consumption municipalities: lung cancer SRR 1.19 (95% CI 1.17 to 1.20; 20,735 deaths); ovarian cancer SRR 1.34 (95% CI 1.31 to 1.37; 8,446 deaths)
  • Pooled typical asbestos-related diseases, by when municipalities began using asbestos. Men: SRR 3.26 (95% CI 2.86 to 3.70) where use began before 1970, and 1.30 (0.99 to 1.67) where it began from 1970 onwards. Women: 1.10 (0.87 to 1.38) and 1.35 (1.01 to 1.79), respectively.
  • Lung and ovarian cancer, by start of asbestos use. Men's lung cancer: SRR 1.40 before 1970 and 1.19 from 1970. Women's lung cancer: 1.19 in both groups. Ovarian cancer: 1.39 before 1970 and 1.26 from 1970.
  • Among typical asbestos-related disease deaths in the high-consumption municipalities, the men-to-women ratio was 1.7 for mesothelioma and 7.4 for the non-malignant diseases. The ratios were 1.4 and 2.0 in the remaining municipalities.
• The authors' conclusion: The authors concluded that there was excess mortality from typical asbestos-related diseases in areas with a long history of high asbestos consumption. They said this was paralleled by excess lung cancer deaths in both sexes and excess ovarian cancer deaths in women. They cautioned that the results come from an ecological study and said analytical studies are needed.
• Limitations the authors state:
  • This was an ecological study based only on residence. As a result, the lung and ovarian cancer analyses could not take potential confounders into account.
  • Patients with typical asbestos-related diseases, mainly the cancers, may have moved from smaller municipalities to larger cities for diagnosis and treatment.
  • Asbestos use began at different times in different municipalities, so the 2000 to 2017 period reflects different exposure conditions in each.
  • Except for the specialized outpatient repository, where clinical data were available, diagnoses came only from health information system records and their accuracy could not be checked.
  • Choosing only mining and asbestos-cement municipalities may not reflect occupational exposure in other sectors or industries.

Topics

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

Medical terms in this study, explained in our Lexicon: Ovarian Cancer, Mesothelioma, Pleural Plaques, Asbestos-Cement, rate ratio, Lung Cancer, Asbestos Exposure, Latency.

Related studies

• Correction: Saito et al. Sex-Specific Mortality from Asbestos-Related Diseases, Lung and Ovarian Cancer in Municipalities with High Asbestos Consumption, Brazil, 2000-2017. Int. J. Environ. Res. Public Health 2022, 19, 3656 — C.A. Saito, M.A. Bussacos, et al. (2022)
• Spatial Analysis of Shared Risk Factors between Pleural and Ovarian Cancer Mortality in Lombardy (Italy) — G. Stoppa, C. Mensi, et al. (2022)
• Analysis of Mortality from Asbestos-Related Diseases in Brazil Using Multiple Health Information Systems, 1996-2017 — E. Algranti, V.S. Santana, et al. (2022)
• Occupational burden of asbestos-related cancer in Argentina, Brazil, Colombia, and Mexico — R. Pasetto, B. Terracini, et al. (2014)
• Evaluation of ovarian cancer biomarkers in subjects with benign asbestos-related pleural diseases — E.K. Park, A.R. Johnson, et al. (2011)
• The next mesothelioma wave: mortality trends and forecast to 2030 in Brazil — E. Algranti, C.A. Saito, et al. (2015)

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