The burden of pneumoconiosis in China: an analysis from the Global Burden of Disease Study 2019

Our plain-English summary of The burden of pneumoconiosis in China: an analysis from the Global Burden of Disease Study 2019, by J. Li, P. Yin, H. Wang, et al (BMC Public Health, 2022).

The study

• Authors: J. Li, P. Yin, H. Wang, L. Wang, J. You, J. Liu, Y. Liu, W. Wang, X. Zhang, P. Niu, M. Zhou
• Journal: BMC Public Health
• Published: 2022;22(1):1114
• Cited by: 52 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Pneumoconiosis refers to a class of serious diseases threatening the health of workers exposed to coal or silicosis dust. However, the burden of pneumoconiosis is unavailable in China.

Methods: Incident cases, deaths, and disability-adjusted life years (DALYs) from pneumoconiosis and its subtypes in China were estimated from the Global Burden of Disease Study 2019 using a Bayesian meta-regression method. The trend of the burden from pneumoconiosis was analyzed using percentage change and annualized rate of change (ARC) during the period 1990-2019. The relationship between subnational socio-demographic index (SDI) and the ARC of age-standardised death rate was measured using Spearman's Rank-Order Correlation.

Results: In 2019, there were 136.8 (95% uncertainty interval [UI] 113.7-162.5) thousand new cases, 10.2 (8.1-13.6) thousand deaths, and 608.7 (473.6-779.4) thousand DALYs from pneumoconiosis in China. Of the global burdens from pneumoconiosis, more than 60% were in China. Both the total number of new cases and DALYs from pneumoconiosis was keeping increasing from 1990 to 2019. In contrast, the age-standardised incidence, death, and DALY rates from pneumoconiosis and its subtypes, except for the age-standardised incidence rate of silicosis, and age-standardised death rate of asbestosis, experienced a significant decline during the same period. The subnational age-standardised death rates were higher in western China than in eastern China. Meanwhile, the subnational ARC of age-standardised death rates due to pneumoconiosis and its subtypes were significantly negatively correlated with SDI in 2019.

Conclusion: China suffers the largest health loss from pneumoconiosis in the world. Reducing the burden of pneumoconiosis is still an urgent task in China.

© 2022. The Author(s).

In plain English

The authors analysed modelled Global Burden of Disease Study 2019 estimates of pneumoconiosis and its subtypes in China, 1990 to 2019. Estimated new cases were 136.8 thousand (113.7 to 162.5 thousand) in 2019, up from 83.6 thousand (69.7 to 101.4 thousand) in 1990. China had 68.7% of global new cases, 44.3% of deaths and 66.2% of DALYs (healthy years lost). Silicosis made up most of the burden. Asbestosis was the smallest subtype, with 3.0% (2.0% to 4.1%) of new cases, 2.3% (1.6% to 4.0%) of deaths and 1.1% (0.8% to 1.9%) of DALYs in 2019. Estimated asbestosis deaths were 186 (117 to 289) in 1990 and 239 (177 to 391) in 2019, but the uncertainty range for the change (-25.14% to 145.13%) included a decrease. Most age-standardised rates declined significantly, except the asbestosis death rate and silicosis incidence rate. In 2019, age-standardised pneumoconiosis death rates were higher in western than in eastern China. The authors concluded that two-thirds of global pneumoconiosis health loss occurs in China. They noted a lack of national and subnational data on occupational dust and fibre exposure levels.

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: Secondary analysis of modelled estimates from the Global Burden of Disease Study 2019, with trends described by percentage change and annualized rate of change, and Spearman correlation with the socio-demographic index
• Who was studied: Population of China, nationally and by province, males and females aged 15 to 80 and older, 1990–2019
• Exposure: No individual exposure data were used. The models used country-level covariates, including asbestos consumption per capita, coal and gold production, and summary exposure values for occupational asbestos, beryllium and silica. Asbestosis was one of four subtypes (ICD-10 J61).
• Main results:
  • New cases of pneumoconiosis in China rose from 83.6 (69.7–101.4) thousand in 1990 to 136.8 (113.7–162.5) thousand in 2019, an increase of 63.7% (40.5% to 86.7%)
  • Of the global pneumoconiosis burden, 68.7% of new cases, 44.3% of deaths and 66.2% of DALYs were in China
  • Pneumoconiosis DALYs in China rose by 20.8% (-5.6% to 64.0%), from 503.8 thousand years in 1990 to 608.7 thousand years in 2019. Deaths remained almost constant: 11,070 in 1990 and 10,201 in 2019.
  • Silicosis accounted for 88.3% (67.4% to 99.3%) of new cases, 75.9% (51.6% to 98.2%) of deaths and 85.4% (58.5% to 99.1%) of DALYs from pneumoconiosis in China in 2019
  • Asbestosis, the smallest subtype, accounted for 3.0% (2.0% to 4.1%) of new cases, 2.3% (1.6% to 4.0%) of deaths and 1.1% (0.8% to 1.9%) of DALYs from pneumoconiosis in China in 2019
  • Estimated asbestosis new cases were 5513 (3746–7788) in 1990 and 4065 (2903–5337) in 2019, a change of -26.26% (-45.01% to -0.68%)
  • Estimated asbestosis deaths were 186 (117–289) in 1990 and 239 (177–391) in 2019, a change of 28.53% with an uncertainty range of -25.14% to 145.13%, which includes both a decrease and an increase
  • Almost all age-standardised incidence, death and DALY rates declined significantly from 1990 to 2019. The exceptions were the silicosis incidence rate and the asbestosis death rate. The asbestosis age-standardised death rate went from 0.02 to 0.01 per 100,000, a change of -45.20% (-66.86% to 4.04%).
  • Males accounted for 93.3% of new cases, 94.5% of deaths and 95.2% of DALYs from pneumoconiosis in China in 2019
  • In 2019, age-standardised pneumoconiosis death rates were higher in western China (especially Xinjiang, Chongqing and Qinghai) than in eastern China (Shanghai, Guangdong and Shandong)
  • Across provinces, the annualized rate of change in age-standardised death rate was negatively correlated with the socio-demographic index. The correlation was r = -0.591 (p less than 0.001) for all pneumoconiosis and r = -0.800 (p less than 0.001) for asbestosis.
• The authors' conclusion: The authors concluded that two-thirds of global health loss from pneumoconiosis occurs in China, and that its prevention and control remain a serious health and social issue there
• Limitations the authors state:
  • National and subnational data on occupational exposure levels of dust and fibers in China were unavailable
  • Other dusts (antimony, barium, graphite and iron) were not included in the models, which may underestimate the burden
  • Occupational epidemiological studies in China are scarce, and GBD uses covariates from developed countries, which may cause uncertainty
  • GBD counts only disabilities from the most common sequelae, not mental disorders
  • Co-exposure to dust and fibers may lead to misclassification between pneumoconiosis subtypes

Topics

Medical terms in this study, explained in our Lexicon: Pneumoconiosis, Silicosis, Incidence.

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