Update of predictions of mortality from pleural mesothelioma in the Netherlands

Our plain-English summary of Update of predictions of mortality from pleural mesothelioma in the Netherlands, by O. Segura, A. Burdorf, C. Looman (Occupational and Environmental Medicine, 2003).

The study

• Authors: O. Segura, A. Burdorf, C. Looman
• Journal: Occupational and Environmental Medicine
• Published: 2003;60(1):50-5
• Cited by: 65 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Aims: To predict the expected number of pleural mesothelioma deaths in the Netherlands from 2000 to 2028 and to study the effect of main uncertainties in the modelling technique.

Methods: Through an age-period-cohort modelling technique, age specific mortality rates and cohort relative risks by year of birth were calculated from the mortality of pleural mesothelioma in 1969-98. Numbers of death for both sexes were predicted for 2000 to 2028, taking into account the most likely demographic development. In a sensitivity analysis the relative deviation of the future death toll and peak death number were studied under different birth cohort risk assumptions.

Results: The age-cohort model on mortality 1969-98 among men showed the highest age specific death rates in the oldest age group (79 per 100 000 person-years in the age group 80-84 years) and the highest relative risks for the birth cohorts of 1938-42 and 1943-47. Among men a small period effect was observed. The age-cohort model was considered the best model for predicting future mortality. The most plausible scenario predicts an increase in pleural mesothelioma mortality up to 490 cases per year in men, with a total death toll close to 12 400 cases during 2000-28. However, using different assumptions this death toll could rise to nearly 15 000 in men (20% increase). Mortality among women remains low, with a total death toll of about 800 cases. It is predicted that the total death toll in the period 2000-28 is 44% lower than previous predictions using mortality data from 1969 to 1993.

Conclusion: Adding five recent years of observed mortality in an age-cohort model resulted in a 44% lower prediction of the future death toll of pleural mesothelioma. A statistically significant period effect was observed, possibly influenced by initial asbestos safety guidelines in the 1970s and introduction of the ICD-10 codification.

In plain English

This study used Dutch death statistics for pleural mesothelioma from 1969–98 to forecast deaths for 2000–28. It did not measure anyone's personal asbestos exposure. During 1969–98, 5526 people in the Netherlands died of pleural mesothelioma, with a male to female ratio of 6.5:1. Deaths in men rose from 65 in 1969 to 265 in 1998. The authors fitted statistical models based on age, year of birth and year of death, and compared four prediction scenarios. In the scenario they judged most plausible, deaths in men were predicted to rise from 333 in 2000 to 490 in 2017, then fall to 338 in 2028, totalling 12,412. Assuming no fall in risk for men born after 1957 raised that predicted total to 14,899. An earlier model using only 1969–93 data had predicted 22,061. The new total for men was therefore 43.7% lower, which the authors gave as 44%. For women, deaths were predicted to fall from 33 in 2000 to 15 in 2028. The predicted total of 783 was 9.1% below the earlier model's 861. The authors stated that the predictions carry high uncertainty.

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: Analysis of national mortality statistics using age-period-cohort (Poisson) modelling to predict future deaths, with a sensitivity analysis comparing four prediction models
• Who was studied: The population of the Netherlands. Deaths from pleural cancer and mesothelioma from 1969 to 1998 came from Statistics Netherlands. Deaths were analysed for ages 25 to 84, with men and women analysed separately. There were 5526 pleural mesothelioma deaths in this period (male to female ratio 6.5:1). Cancer Registry data from 1989 to 1997 were also used.
• Exposure: Historical asbestos use in the Netherlands in general. It was not measured for individuals and not broken down by fiber type. The models assumed that risk falls in later birth cohorts because asbestos use after 1984 was very small and asbestos was banned in 1993.
• Main results:
  • Observed deaths in men rose from 65 in 1969 to 265 in 1998. The male death rate rose from 1.0 per 100 000 in 1969 to 3.9 per 100 000 in 1993 and stayed roughly stable after that.
  • Observed deaths in women followed an irregular pattern, peaking at 43 in 1994 and falling to 19 in 1998.
  • In the age-cohort model, death rates rose with age and were highest at ages 80–84 in both sexes. For men aged 80–84 the rate was 78.650 per 100 000 person-years (95% CI 63.322 to 97.688). For women aged 80–84 it was 2.771 (95% CI 1.468 to 5.230).
  • Among men, risk by birth cohort was highest for those born 1938–42 (relative risk 1.03, 95% CI 0.82 to 1.29), compared with the reference cohort born 1943–47 (set at 1). Risk was lower for men born 1953–57 (0.67, 95% CI 0.45 to 0.99). Among women there was no specific trend over time.
  • Among men, the age-cohort model fitted best. Adding a period effect that separated 1996 onwards from earlier years was statistically significant (change in deviance 24, df = 1). Even so, overall fit was very similar to the age-cohort model.
  • Model 3 was the scenario the authors regarded as most plausible. In it, deaths in men were predicted to rise from 333 in 2000 to a plateau of 490 in 2017, then fall to 338 in 2028. The total for 2000–28 was 12 412.
  • Model 1 was the older model, based on 1969–93 data, with a peak of 960 deaths in 2027 and a total of 22 061. Compared with it, model 3 for men predicted a 49.0% lower peak and a 43.7% lower total death toll for 2000–28.
  • Model 2 assumed men born after 1957 kept the risk of the 1953–57 cohort. For men it predicted a peak of 613 deaths in 2028 and a total of 14 899. This is 25% higher in peak and 20% higher in total than model 3.
  • Model 4, which added a period effect, differed little from model 3 for men, with a peak of 501 and a total of 12 435.
  • For women, all models were fairly similar and predicted a continuous decrease from 33 deaths in 2000 to 15 in 2028. Model 3 gave a total of 783 deaths for 2000–28, which is 9.1% lower than model 1's 861.
  • The authors estimated that if the age make-up of the population stayed unchanged, the predicted peak would come slightly earlier and be at least 20% lower.
• The authors' conclusion: The authors concluded that adding the 1994–98 mortality data produced a predicted 2000–28 death toll 44% lower than previous predictions based on 1969–93 data. In their Table 4 this figure corresponds to men (43.7% lower); for women the reduction was 9.1%. They found the predictions were most influenced by age-specific rates and, to a lesser extent, by assumptions about birth cohort risks. They also concluded that population ageing, early asbestos control measures and changes in disease coding may play a role.
• Limitations the authors state:
  • Both the mortality registry and the cancer registry may be incomplete, and cases may be misclassified between pleural cancer and pleural mesothelioma.
  • Data protection rules meant individual patient records were not available, so mortality and cancer registry data could not be compared directly.
  • The rise in male rates may partly reflect growing diagnostic awareness. The authors say this cannot be tested, though they cite some evidence against a strong effect.
  • Risks for men born 1958–62 and later could not be estimated because too few cases have been observed, so they had to be assumed.
  • The predictions assume that age-specific rates stay constant, and they carry high uncertainty.
  • The fit of the statistical models calls for caution in interpreting the predictions.
  • Future demographic change, especially population ageing, adds uncertainty to the predictions.

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, Relative Risk.

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