Spatio-temporal trends in pleural mesothelioma mortality in Italy: a 40-year analysis by calendar period and birth cohort

Our plain-English summary of Spatio-temporal trends in pleural mesothelioma mortality in Italy: a 40-year analysis by calendar period and birth cohort, by A. Sartore, G. Stoppa, G. Minelli, et al (International Journal of Epidemiology, 2026).

The study

• Authors: A. Sartore, G. Stoppa, G. Minelli, L. Fazzo, V. Manno, C. Mensi, A. Marinaccio, A. Biggeri, D. Catelan
• Journal: International Journal of Epidemiology
• Published: 2026;55(1)
• Cited by: 2 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Italy, among the leading asbestos producers and users until the national ban in 1992, continues to register a high burden of asbestos-related diseases, mainly due to their long latency and delays in remediation. This study investigates the spatio-temporal evolution of pleural mesothelioma (PM) mortality over the past 40 years.

Materials And Methods: Malignant pleural tumours and PM deaths (1980-2020) were extracted from the national death registry, adjusted for misclassification of pleural tumours, and analysed by region and birth cohort (1905-1984). The analyses by calendar period and cohort, stratified by sex assigned at birth, were followed by a space-cohort Bayesian Hierarchical Model with structured random effects for time (cohorts up to 1960-1969) and space (administrative regions).

Results: In Italy, from 1980 to 2020, 35 134 people died from PM (24 380 males and 10 754 females). A mortality decrease was observed in males after 2010-14 and in females after 2000-4. Mortality steadily declined in both males and females across cohorts after 1935-44. The space-time analysis enabled the clear identification of the Italian regions most affected by PM.

Conclusion: Italy's trend mirrors those of other Western countries that have banned asbestos, with the highest risks for birth cohorts in working age before the ban. The results reveal distinct spatio-temporal patterns, with the northern regions exhibiting the highest rates. The Italian experience with asbestos-related diseases detection could help other countries to assess the impact of asbestos, raise awareness, and promote a global ban on asbestos.

© The Author(s) 2026. Published by Oxford University Press on behalf of the International Epidemiological Association.

In plain English

This study analysed pleural mesothelioma deaths in Italy's national death registry from 1980 to 2020, by calendar period, birth cohort and region. It did not measure individual asbestos exposure. For 1995–2002, the authors used death-certificate wording to identify mesothelioma among unspecified pleural cancer deaths. They then applied the proportion found in 1995 to estimate counts back to 1980. Of 40 702 malignant pleural tumour deaths, 35 134 were counted as pleural mesothelioma (24 380 males, 10 754 females), averaging 878 yearly. In males, standardized death rates rose until 2014, then plateaued with a slight decrease. The trend in females was less clear. People born between 1935 and 1949 were most affected, and later-born cohorts showed a consistent decrease in both sexes. Northern regions had higher risks than southern ones. The highest relative risks were in Liguria for males (3.22, 95% credibility interval 2.98 to 3.52) and in Piedmont for females (2.45, 2.16 to 2.76). The authors concluded that mortality risk persists in Italy, though it is decreasing in younger generations. They noted that misclassification cannot be excluded and that residence at death may not reflect where exposure occurred.

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-based analysis of national mortality data over time and space: standardized rates and SMRs, age-period-cohort models, and a hierarchical Bayesian space-cohort model
• Who was studied: All deaths from malignant pleural tumours (ICD-9 163) and pleural mesothelioma (ICD-10 C45.0) in Italy, 1980–2020, by sex, across 20 regions and 15 birth cohorts (1905–14 to 1975–84). The Bayesian model used cohorts up to 1960–69 because later cohorts had too few cases.
• Exposure: Asbestos exposure was not measured for individuals. Trends were interpreted against Italy's asbestos use before the national ban in 1992.
• Main results:
  • For 1995–2002, among 8508 deaths coded 163.9 (malignant neoplasm of pleura, unspecified), the authors identified 6242 deaths from pleural mesothelioma using death-certificate wording.
  • For earlier years back to 1980, counts were adjusted by applying the proportion of mesothelioma among all pleural cancers observed in 1995. Wording was not checked year by year for that period.
  • From 1980 to 2020, 40 702 people died from malignant pleural tumours (28 117 males, 12 585 females). After correction, 35 134 of these were pleural mesothelioma (24 380 males, 10 754 females), averaging 878 deaths per year.
  • The last period, 2015–20, had the highest number of deaths.
  • The age group with the highest mortality was 75–79 years, with 4716 deaths among males and 2089 among females over the whole period. The male/female ratio over the whole period was 2.27.
  • In males, direct standardized death rates increased steadily until 2014, then reached a plateau with a slight decrease in the last period. This trend was not as evident in females.
  • Females had a higher SMR than males until 1999, and their SMR was still above the national standard at the end of the observation period.
  • By birth cohort, the most affected cohorts were those born between 1935 and 1949, in both males and females.
  • For cohorts born after that peak, mortality decreased clearly and consistently in both sexes.
  • In males, the highest regional risk was in Liguria (RR 3.22, 95% credibility interval 2.98 to 3.52), followed by Friuli-Venezia Giulia (RR 2.27, 1.96 to 2.61).
  • In females, the highest regional risk was in Piedmont (RR 2.45, 95% credibility interval 2.16 to 2.76), followed by Lombardy (RR 1.82, 1.66 to 1.98) and Liguria (RR 1.80, 1.56 to 2.06).
  • Northern regions consistently showed higher risks than southern regions.
  • Only Liguria showed consistently elevated risks in the youngest birth cohorts, for both males and females.
• The authors' conclusion: The authors concluded that Italy shows a persistent pleural mesothelioma mortality risk, even though it is decreasing in younger generations. They said its trend resembles that of other Western countries that banned asbestos, with the highest risks among people who lived or started working before the ban.
• Limitations the authors state:
  • Misclassification cannot be excluded, including for cases in young people, because death-certificate wording could be used to correct the older codes only from 1995 onward.
  • An effect of improved survival on the recent decrease in mortality cannot be excluded. The authors argue the effect is unlikely to be large, because they found no period effect in the age-period-cohort models.
  • Place of residence at death may not reflect where exposure occurred, because of migration after retirement.

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, Latency.

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• 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)
• Peritoneal mesothelioma in Italy: Trends and geography of mortality and incidence — S. Conti, G. Minelli, et al. (2015)
• Cancer mortality by country of birth and cancer type in Sweden: A 25-year registry-based cohort study — D.N. Tollosa, K. Zendehdel, et al. (2024)

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