The global burden of cancers attributable to occupational factors, 1990-2021

Our plain-English summary of The global burden of cancers attributable to occupational factors, 1990-2021, by B. Zou, P. Wu, J. Chen, et al (BMC Cancer, 2025).

The study

• Authors: B. Zou, P. Wu, J. Chen, J. Luo, Y. Lei, Q. Luo, B. Zhu, M. Zhou
• Journal: BMC Cancer
• Published: 2025;25(1):503
• Cited by: 16 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

This study assessed the global cancer burden due to occupational carcinogens (OCs) using data from Global Burden of Disease (GBD) 2021. Mortality and disability-adjusted life years (DALYs) were employed to assess the evolving trend of cancer attributable to occupational risk. The analysis was conducted by age, year, geographical location, and socio-demographic index (SDI). Subsequently, the estimated annual percentage change (EAPC) values were calculated. Globally, asbestos exposure showed the most severe impact on age-standardized death rate (ASDR) and age-standardized DALY rate but decreased significantly. Conversely, diesel engine exhaust exposure increased, with EAPCs of 0.80 for deaths. Trichloroethylene exposure, although low in absolute terms, exhibited the fastest growth with an EAPC of 1.21 in age-standardized DALY rate. Notably, diesel engine exhaust exposure in South Asia and polycyclic aromatic hydrocarbons (PAHs) in Southeast Asia, East Asia, and Oceania increased significantly in age-standardized DALY rate. Regions with low to middle SDI, such as South Asia and sub-Saharan Africa, showed the highest increases in OC-related cancer burdens in age-standardized DALY rate. Lesotho, Kenya, and Egypt exhibited the fastest growth, with EAPCs in age-standardized DALY rate of 3.45, 2.13, and 2.95, respectively. High-income regions like the Netherlands, the United Kingdom, and Italy had the most severe OC-related cancer of ASDR burdens in 2021. OC exposure remains a major contributor to the global cancer burden, especially from asbestos and silica. Exposure to diesel engine exhaust was associated with increased risk of cancers, particularly in low -to -middle SDI regions such as South Asia and sub-Saharan Africa.

© 2025. The Author(s).

In plain English

Using existing Global Burden of Disease (GBD) 2021 estimates rather than new data on workers, this study examined 204 countries and territories from 1990 to 2021. It looked at cancer deaths and disability-adjusted life years (DALYs, years of healthy life lost) that GBD attributes to 13 workplace carcinogens. These included asbestos, which GBD links to lung, laryngeal and ovarian cancer and mesothelioma. Results were not split by asbestos fiber type. Asbestos was the leading cause of attributable deaths and DALYs worldwide. Its age-standardized death and DALY rates per 100,000 fell from 3.97 (95% uncertainty interval 2.97 to 4.96) and 78.70 (58.52 to 99.73) in 1990 to 2.71 (2.00 to 3.39) and 47.78 (35.61 to 60.39) in 2021. For all carcinogens combined, the age-standardized DALY rate fell from 117.04 (93.01 to 142.33) to 82.13 (65.63 to 101.45). Rates rose in some places, including South Asia and Croatia, and the burden was higher in males than females. The authors concluded that asbestos and silica were responsible for a large share of this burden. They noted data gaps and possible over- or underestimation.

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 published Global Burden of Disease 2021 estimates (no new data collected), with trend analysis using estimated annual percentage change and correlation with the Socio-demographic Index
• Who was studied: Population-level estimates for 204 countries and territories, grouped into 21 regions and 7 super-regions, both sexes, all ages, 1990 to 2021
• Exposure: 13 occupational carcinogens as defined by GBD 2021. These included asbestos, which GBD links to tracheal, bronchial and lung cancer, larynx cancer, mesothelioma and ovarian cancer. The others included silica, diesel engine exhaust, PAHs and trichloroethylene. Burden estimates are not split by asbestos fiber type; blue asbestos is mentioned only in the discussion of European bans. No exposure doses are given.
• Main results:
  • Asbestos was the leading occupational carcinogen for attributable cancer deaths and DALYs worldwide
  • Globally, the age-standardized DALY rate attributable to occupational asbestos exposure fell from 78.70 (95% UI 58.52 to 99.73) per 100,000 in 1990 to 47.78 (95% UI 35.61 to 60.39) in 2021
  • Globally, the age-standardized death rate attributable to occupational asbestos exposure fell from 3.97 (95% UI 2.97 to 4.96) per 100,000 in 1990 to 2.71 (95% UI 2.00 to 3.39) in 2021
  • In Table 1, the estimated annual percentage change for asbestos was -1.50 (95% CI -5.42 to 2.58) for the DALY rate and -1.08 (95% CI -2.12 to -0.03) for the death rate
  • For all 13 occupational carcinogens combined, the global age-standardized DALY rate fell from 117.04 (95% UI 93.01 to 142.33) per 100,000 in 1990 to 82.13 (95% UI 65.63 to 101.45) in 2021
  • For all occupational carcinogens combined, the age-standardized DALY rate in South Asia rose from 20.92 (95% UI 15.58 to 26.32) in 1990 to 25.05 (95% UI 19.08 to 32.63) in 2021. The reported EAPC for this change was 0.49% (95% CI -2.85 to 3.94).
  • For all occupational carcinogens combined, Croatia's age-standardized DALY rate rose from 133.68 (95% UI 95.09 to 175.52) to 222.76 (95% UI 158.73 to 298.51). The reported EAPC for this change was 2.75% (95% CI -2.96 to 8.79).
  • In 2021, the DALY burden from all occupational carcinogens combined was higher in males than in females at all ages
  • At the national level in 2021, the authors found no significant association between the Socio-demographic Index and occupational-carcinogen death or DALY rates (R = -0.12 for death rate; R = -0.14 for DALY rate)
• The authors' conclusion: The authors concluded that occupational carcinogen exposure has caused a large global cancer burden, and that asbestos and silica were responsible for a large proportion of it over the 31 years studied
• Limitations the authors state:
  • The analysis relies on secondary data sources and may miss subnational differences and emerging occupational risks
  • Epidemiological data are limited for certain cancers
  • Interactions between multiple occupational and non-occupational risk factors were not explicitly considered
  • Methodological constraints may cause the attributable burden to be overestimated or underestimated
  • The analysis relies on population-level estimates and does not fully account for latency periods

Topics

Medical terms in this study, explained in our Lexicon: Asbestos Exposure.

Related studies

• Global burden of mesothelioma attributable to occupational asbestos exposure in 204 countries and territories: 1990-2019 — Z. Chen, Y. Cai, et al. (2024)
• Global, regional, and national burden of ovarian cancer among young women during 1990-2019 — Q. Zhuang, G. Gu, et al. (2025)
• Global burden of tracheal, bronchus, and lung cancer attributable to occupational carcinogens in 204 countries and territories, from 1990 to 2019: results from the global burden of disease study 2019 — Y. Zhang, M. Mi, et al. (2023)
• Global and regional burden of disease and injury in 2016 arising from occupational exposures: a systematic analysis for the Global Burden of Disease Study 2016 — GBD 2016 Occupational Risk Factors Collaborators (2020)
• The global burden and associated factors of ovarian cancer in 1990-2019: findings from the Global Burden of Disease Study 2019 — S. Zhang, C. Cheng, et al. (2022)
• Global, regional, and national burden of non-communicable diseases attributable to occupational asbestos exposure 1990-2019 and prediction to 2035: worsening or improving? — X. Miao, T. Yao, et al. (2024)

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