Trends in Mesothelioma Mortality in the United States Between 1999 and 2020

Our plain-English summary of Trends in Mesothelioma Mortality in the United States Between 1999 and 2020, by A.J. Didier, M. Li, J. Gheeya, et al (JTO Clinical and Research Reports, 2025).

The study

• Authors: A.J. Didier, M. Li, J. Gheeya, A. Alahmadi, J. Kaufman, R. Memmott, K. He, P. Shields, D.P. Carbone, C. Presley, D. Owen, L. Roof
• Journal: JTO Clinical and Research Reports
• Published: 2025;6(5):100804
• Cited by: 5 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Introduction: Mesothelioma is a rare but aggressive cancer primarily caused by asbestos exposure. In March 2024, the Environmental Protection Agency banned asbestos in the United States, but its use will take years to phase out. Therefore, asbestos remains a threat, and incidence may remain stable or slowly decrease due to the long latency between exposure and diagnosis. This study investigates mesothelioma mortality trends in the United States from 1999 to 2020, focusing on demographic and geographic variations.

Methods: Data on mesothelioma-related deaths from 1999 to 2020 were extracted from the Centers for Disease Control and Prevention database. Variables including race/ethnicity, sex, geographic density, and mesothelioma subtype were assessed. Age-adjusted mortality rates were calculated per 1 million individuals and standardized to the 2000 United States population. Joinpoint regression identified statistically significant changes in mortality trends over time.

Results: From 1999 to 2020, there were 54,905 mesothelioma-related deaths in the United States (age-adjusted mortality rate = 7.5). Pleural mesothelioma accounted for 8.1% of deaths, peritoneal for 4.6%, pericardial for 0.01%, other sites for 10.9%, and unspecified sites for 76.3%. Most deaths (81.3%) occurred in individuals aged over 65 years. Overall mortality decreased from 8.5 in 1999 to 5.7 in 2020 at -1.9% annually. Non-Hispanic Whites had the highest mortality, and male individuals experienced higher mortality than female individuals. Suburban and rural populations had the highest mortality rates.

Conclusions: The study highlights significant declines in mesothelioma mortality in the United States from 1999 to 2020, with variations across demographic and geographic groups. Continued monitoring and targeted interventions are necessary to address disparities and further reduce mesothelioma mortality.

© 2025 The Authors.

In plain English

This study used the CDC WONDER national death-certificate database to examine U.S. mesothelioma deaths from 1999 to 2020. It did not measure anyone's asbestos exposure or occupation. There were 54,905 mesothelioma deaths, an age-adjusted rate of 7.5 per 1 million people, and 81.3% of the deaths were in people over 65. Death certificates named the pleura for 4455 deaths and the peritoneum for 2509, and 41,866 gave no site. The overall rate fell from 8.5 in 1999 to 5.7 in 2020, at 1.9% a year. Among people over 65, the pleural mesothelioma rate fell until 2010 and then rose 7.7% a year to 5.7 in 2020. The authors said this trend may have been confounded by the many unspecified-site deaths. Rates were higher in men (14.0) than in women (2.8), and higher in non-Hispanic White people (8.5) than in Hispanic (4.3) or non-Hispanic Black (3.3) people. Among those over 65, suburban areas had the highest rate (54.3), followed by rural (45.7) and urban (40.7) areas. The authors concluded that mortality decreased significantly and that more work is needed for vulnerable subgroups.

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 death-certificate data (CDC WONDER), using age-adjusted mortality rates and joinpoint regression to test trends over time
• Who was studied: All 54,905 deaths coded as mesothelioma (ICD-10 C45.0, C45.1, C45.2, C45.7 and C45.9) in the United States, 1999 to 2020. Most subgroup analyses were done in people aged over 65.
• Exposure: Asbestos exposure was not measured. The database has no occupation data. Deaths were grouped by anatomical site (pleura, peritoneum, pericardium, other, unspecified), race/ethnicity, sex, urban/suburban/rural residence and state.
• Main results:
  • The overall age-adjusted mesothelioma mortality rate (per 1 million) fell from 8.5 in 1999 to 5.7 in 2020, at 1.9% annually.
  • By site: 4455 deaths (8.1%) were pleural and 2509 (4.6%) were peritoneal. 41,866 deaths had an unspecified site, which the authors describe as roughly 75% of deaths.
  • Most deaths were in people aged over 65: 44,620 of 54,905 (81.3%).
  • In people over 65, the pleural mesothelioma mortality rate fell from 5.3 in 1999 to 2.8 in 2010 (5.7% annually). It then rose to 5.7 in 2020 (7.7% annually).
  • In people over 65, the peritoneal mesothelioma mortality rate increased from 1.5 to 2.1, at 2.0% annually.
  • In people over 65, mortality from all mesotheliomas was highest in suburban areas (54.3), then rural (45.7) and urban (40.7) areas. Urban rates fell 2.0% annually and suburban rates 1.5% annually. Rural populations showed no statistically significant trend.
  • All ages, by race/ethnicity: non-Hispanic White 8.5, Hispanic 4.3, non-Hispanic Black 3.3. Over 65, the corresponding rates were 55.5, 26.4 and 20.5.
  • All ages, by sex: men had an average mortality rate of 14.0 and women 2.8.
  • By state, in adults over 65: the highest rates were in Alaska (80.1), Washington (76.2) and Delaware (75.3). The lowest were in Arkansas (28.5), Hawaii (27.9) and Georgia (27.8).
• The authors' conclusion: The authors concluded that U.S. mesothelioma mortality decreased significantly between 1999 and 2020. They suggested this may be related to new developments such as immunotherapy, and said further work is needed for vulnerable subgroups.
• Limitations the authors state:
  • Incidence could not be assessed because the data come from death certificates.
  • Most deaths had an unspecified anatomical site because of incomplete death-certificate information.
  • The rising pleural trend may have been confounded by the many unspecified-site deaths, which may represent pleural mesothelioma.
  • Mortality could not be assessed by histologic subtype.
  • Younger age groups could not be assessed because of sample size and unreliable data.
  • The database records the state where the death occurred, which may differ from the state of residence.
  • Deaths may have been miscoded in the database.
  • There were no occupation data, so the authors could not explain the sex and race differences within the data set.

Topics

Medical terms in this study, explained in our Lexicon: Mesothelioma, Asbestos Exposure, Latency, Pleural Mesothelioma, Pericardial.

Related studies

• Trends in Pleural Mesothelioma Incidence and Survival in Metropolitan and Nonmetropolitan Areas in the United States — A.J. Didier, C. Lennox, et al. (2025)
• Mesothelioma trends in the United States: an update based on Surveillance, Epidemiology, and End Results Program data for 1973 through 2003 — B. Price, A. Ware (2004)
• Time trend of mesothelioma incidence in the United States and projection of future cases: an update based on SEER data for 1973 through 2005 — B. Price, A. Ware (2009)
• Recent trends in mesothelioma incidence in the United States — R. Spirtas, G.W. Beebe, et al. (1986)
• Trends in Pneumoconiosis Deaths - United States, 1999-2018 — J.L. Bell, J.M. Mazurek (2020)
• Contemporary Trends in Malignant Peritoneal Mesothelioma: Incidence and Survival in the United States — L. Calthorpe, F. Romero-Hernandez, et al. (2022)

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