The Ecological Association between Asbestos Consumption and Asbestos-Related Diseases 15 Years Later

Our plain-English summary of The Ecological Association between Asbestos Consumption and Asbestos-Related Diseases 15 Years Later, by E.M. Rath, M.L. Yuen, C.O. Odgerel, et al (Environmental Health Perspectives, 2022).

The study

• Authors: E.M. Rath, M.L. Yuen, C.O. Odgerel, R.T. Lin, M. Soeberg, A.K. Nowak, K. Takahashi
• Journal: Environmental Health Perspectives
• Published: 2022;130(5):57703
• Cited by: 8 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Summary of the article

This research letter updated the authors' 2007 international ecological analysis to see whether the associations between deaths from mesothelioma and asbestosis and historical asbestos consumption had changed. Deaths by sex and 5-year age group were taken from the WHO mortality database (ICD-10 codes C45.0 pleural mesothelioma, C45.1 peritoneal mesothelioma, C45 all mesothelioma, J61 asbestosis). They were age-standardized to the world standard population and averaged for 2010–2014. Asbestos consumption for 1970, 1975 and 1980 was taken from the U.S. Geological Survey and averaged. Log-transformed mortality rates were regressed on per-capita consumption. Slovenia was removed as an outlier because its consumption data were unreliable. The all-mesothelioma analyses covered 71 countries for men and 69 for women. Consumption was a highly significant predictor of all-mesothelioma mortality, with adjusted R2 of 0.39 for men and 0.30 for women (both p < 0.0001). Each 1 kg per capita increase in consumption was linked to a 2.4-fold (95% CI: 1.8, 3.0) increase in deaths in men and a 1.8-fold (95% CI: 1.4, 2.2) increase in women. Background rates were 0.56 and 0.35 deaths per million. Seven of eight disease–sex combinations showed significant positive associations; asbestosis in women did not. The authors concluded that the associations remained consistent with 2007, although somewhat reduced for mesothelioma, and that eliminating asbestos consumption must be a priority.

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In plain English

This research letter updated the authors' 2007 ecological study, which compares countries rather than individual people. Using the WHO mortality database, the authors calculated age-standardized death rates for 2010 to 2014 from pleural, peritoneal and all mesothelioma and from asbestosis. They compared these with each country's historical asbestos consumption per person, averaged from U.S. Geological Survey figures for 1970, 1975 and 1980. Up to 71 countries were analyzed, and Slovenia was removed as an outlier. For all mesothelioma, each additional kilogram of asbestos per person was associated with a 2.4-fold (95% CI 1.8 to 3.0) increase in deaths in men and a 1.8-fold (95% CI 1.4 to 2.2) increase in women. Positive associations were statistically significant for seven of eight disease and sex groups, but not for asbestosis in women. Compared with 2007, the associations remained consistent, though somewhat reduced for mesothelioma. The authors noted that consumption may not reflect actual exposure, that fiber types were not distinguished, and that possible confounders were not accounted for. They concluded that their findings support making the elimination of asbestos consumption a priority.

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: International ecological (country-level) study using regression of national mortality rates against historical asbestos consumption; an update of the authors' 2007 study, published as a research letter
• Who was studied: Countries reporting deaths to the WHO mortality database. The number of countries ranged from 30 (asbestosis, women) to 71 (all mesothelioma, men), depending on disease and sex. Deaths were age-standardized and averaged for 2010–2014. Slovenia was removed as an outlier because of unreliable consumption data.
• Exposure: Per-capita national asbestos consumption (kilograms per person per year), from U.S. Geological Survey data for 1970, 1975 and 1980, averaged; fiber types were not distinguished
• Main results:
  • All mesothelioma: for each 1 kg per capita increase in asbestos consumption, men had a 2.4-fold (95% CI: 1.8, 3.0) increase and women a 1.8-fold (95% CI: 1.4, 2.2) increase in deaths
  • All mesothelioma: asbestos consumption was a significant predictor of mortality, with adjusted R2 of 0.39 (p less than 0.0001) in men and 0.30 (p less than 0.0001) in women
  • All mesothelioma: estimated background mortality at zero consumption was 0.56 (95% CI: 0.31, 1.01) deaths per million in men and 0.35 (95% CI: 0.22, 0.57) in women
  • Statistically significant positive associations for seven of eight disease and sex combinations (pleural, peritoneal and all mesothelioma and asbestosis, by sex); not significant for asbestosis in women
  • Compared with the 2007 study, the associations remained consistent, though somewhat reduced for mesothelioma, and held when more countries, including economically developing countries, were added
• The authors' conclusion: The authors concluded that their updated analysis supports the recommendation that eliminating asbestos consumption must be a priority in efforts to eliminate asbestos-related diseases
• Limitations the authors state:
  • Per-capita asbestos consumption may not represent actual exposure
  • No distinction between fiber types (e.g., amphiboles, chrysotile)
  • Population attributes that may have confounded the association were not accounted for
  • Lung cancer was not analyzed because of its known causal relationship with smoking

Topics

Medical terms in this study, explained in our Lexicon: Mesothelioma, Pleural Mesothelioma, Peritoneal Mesothelioma, Background Rate.

Related studies

• Ecological association between asbestos-related diseases and historical asbestos consumption: an international analysis — R.T. Lin, K. Takahashi, et al. (2007)
• Malignant mesothelioma in Metsovo, Greece, from domestic use of asbestos: 30 years later — A. Gogali, C. Manda-Stachouli, et al. (2012)
• Asbestos consumption, asbestos exposure and asbestos-related occupational diseases in Germany — O. Hagemeyer, H. Otten, et al. (2006)
• Sex-Specific Mortality from Asbestos-Related Diseases, Lung and Ovarian Cancer in Municipalities with High Asbestos Consumption, Brazil, 2000-2017 — C.A. Saito, M.A. Bussacos, et al. (2022)
• 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)
• Potential years of life lost (PYLL) caused by asbestos-related diseases in the world — R. Diandini, K. Takahashi, et al. (2013)

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