Trends and geographical patterns of pleural mesotheliomas in the Netherlands 1970-87

Our plain-English summary of Trends and geographical patterns of pleural mesotheliomas in the Netherlands 1970-87, by J.M. Meijers, H.T. Planteydt, J.J. Slangen, et al (British Journal of Industrial Medicine, 1990).

The study

• Authors: J.M. Meijers, H.T. Planteydt, J.J. Slangen, G.M. Swaen, C. van Vliet, F. Sturmans
• Journal: British Journal of Industrial Medicine
• Published: 1990;47(11):775-81
• Cited by: 25 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text
• In J-M's library: Johns-Manville's company medical library held a copy (J-M no. 003780).

Abstract

The sex and age related trends and geographical distribution of asbestos related mortality from pleural mesothelioma in the Netherlands between 1970 and 1987 were investigated. Deaths from pleural malignancies recorded by the Dutch Central Bureau of Statistics (CBS) were used and death rates were age adjusted per year by the indirect method. Standardised mortality ratios (SMRs) were computed for 43 regions over the period 1979-86. For men, total mortality increased from 10.8 per million in the period 1970-8 to 20.9 per million during 1979-87. The highest mortality occurred in the group aged between 65 and 74 with 147.7 per million in 1987. The death rate for the group aged between 55 and 64 was 96.5 per million in 1987. For women, total death rates for pleural mesothelioma showed a moderate increase from 2.5 per million in the period 1970-8 to 3.6 per million during 1979-87. The highest mortality occurred in the group aged over 65, fluctuating around 10-15 per million. For men and women under 45 mortality was very low and presented no upward trend. The geographical distribution over the country for the period 1979-86 showed a pattern with a clear concentration of deaths from mesothelioma in men, in conurbations with many harbours, shipyards, and heavy industry near the river mouths and along the North Sea Coast.

In plain English

This study used national death records from the Dutch Central Bureau of Statistics to describe deaths from pleural malignancies in the Netherlands from 1970 to 1987. The authors referred to these as deaths from pleural mesothelioma. Among men, the average yearly death rate rose from 10.8 per million in 1970-78 to 20.9 per million in 1979-87. Among women it rose from 2.5 to 3.6 per million. The highest rate was among men aged 65 to 74, at 147.7 per million in 1987. Rates for people under 45 stayed very low. For 1979-86, the authors compared observed with expected deaths in 43 regions. For men, the highest ratio was in Rijnmond, where the port of Rotterdam is. There were 274 deaths there and an SMR of 280.0 (95% confidence interval 248 to 315), which the authors described as an almost threefold increase. For women, only Amsterdam City and West Groningen showed significant excesses. The authors attributed the male clusters in harbour and coastal areas to past occupational asbestos exposure. They expected deaths to keep rising and called their projections to 2010 highly speculative.

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: Descriptive study of national death statistics (trends over time and comparison of regions using standardised mortality ratios)
• Who was studied: Deaths from pleural malignancies in the whole population of the Netherlands, 1970-87. Trends were analysed by sex and age group. Regional comparisons covered 43 regions for 1979-86.
• Exposure: The study used only counts of deaths and of inhabitants, and did not measure anyone's asbestos exposure. The authors interpreted regional excesses in men as reflecting past occupational asbestos exposure in areas with harbours, shipyards and heavy industry, where workers used asbestos for insulation and other technical purposes.
• Main results:
  • Men, all ages: the average death rate rose from 10.8 per million in 1970-78 to 20.9 per million in 1979-87 (680 and 1394 deaths).
  • Women, all ages: the death rate rose moderately from 2.5 per million in 1970-78 to 3.6 per million in 1979-87 (158 and 244 deaths).
  • Men aged 65 to 74 had the highest mortality, at 147.7 per million in 1987.
  • Men aged 55 to 64: the rate rose from 33.6 per million in 1970 to 96.5 per million in 1987.
  • The ratio of male to female deaths went from 3.7 to 1 in 1970 to 7.3 to 1 in 1987.
  • Men in Rijnmond (Rotterdam harbour area), 1979-86: 274 observed deaths, SMR 280.0 (95% CI 248-315). The authors described this as an almost threefold increase.
  • Men in IJmond (SMR 229.9, 95% CI 157-325) and North Sealand (SMR 257.4, 95% CI 197-330) showed more than twofold excesses. Amsterdam City men had an SMR of 184.4 (95% CI 153-220).
  • In the other 34 Dutch regions there was no significant excess for men.
  • Women: only Amsterdam City (SMR 203.9, 95% CI 137-293) and West Groningen (SMR 244.3, 95% CI 134-410) showed a significant increase. The authors had no explanation for the West Groningen excess.
  • In 1986, 171 histologically verified pleural mesotheliomas were identified through the mesothelioma panel and a pathology laboratory questionnaire. The national death figure for that year was 193.
  • A linear projection gave about 50 per million for men and 5.8 per million for women in 2010.
• The authors' conclusion: The authors concluded that asbestos-related mesothelioma mortality is a serious health problem in the Netherlands and is likely to increase in the near future. They did not expect a significant decrease for about another 20 years.
• Limitations the authors state:
  • Death counts based on the ICD classification of pleural malignancies could under- or overestimate the true number of pleural mesotheliomas. Diagnosis can be difficult, and changing awareness over time could cause classification bias. The authors judged that misclassification had not seriously influenced the results.
  • The projections to 2010 are highly speculative because exact information on how exposure varied over time is lacking.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma.

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

Related studies

• Mortality Patterns among Commercial Painters in The Netherlands — C.W. Terstegge, G.M. Swaen, et al. (1995)
• Linking expert judgement and trends in occupational exposure into a job-exposure matrix for historical exposure to asbestos in the Netherlands — P. Swuste, M. Dahhan, et al. (2008)
• Treatment patterns and survival analysis in 9014 patients with malignant pleural mesothelioma from Belgium, the Netherlands and England — R.A. Damhuis, A. Khakwani, et al. (2015)
• Malignant Peritoneal Mesothelioma: Patterns of Care and Survival in the Netherlands: A Population-Based Study — N.L. de Boer, J.P. van Kooten, et al. (2019)
• Explaining differences in incidence rates of pleural mesothelioma between Sweden and the Netherlands — A. Burdorf, B. Järvholm, et al. (2005)
• Occupational exposure to carcinogens and risk of lung cancer: results from The Netherlands cohort study — A.J. van Loon, I.J. Kant, et al. (1997)

Browse more research in British Journal of Industrial Medicine, or return to medical research.