Recent mortality from pleural mesothelioma, historical patterns of asbestos use, and adoption of bans: a global assessment

Abstract

Background: In response to the health risks posed by asbestos exposure, some countries have imposed strict regulations and adopted bans, whereas other countries have intervened less and continue to use varying quantities of asbestos.

Objectives: This study was designed to assess, on a global scale, national experiences of recent mortality from pleural mesothelioma, historical trends in asbestos use, adoption of bans, and their possible interrelationships.

Methods: For 31 countries with available data, we analyzed recent pleural mesothelioma (International Classification of Diseases, 10th Revision) mortality rates (MRs) using age-adjusted period MRs (deaths/million/year) from 1996 to 2005. We calculated annual percent changes (APCs) in age-adjusted MRs to characterize trends during the period. We characterized historical patterns of asbestos use by per capita asbestos use (kilograms per capita/year) and the status of national bans.

Results: Period MRs increased with statistical significance in five countries, with marginal significance in two countries, and were equivocal in 24 countries (five countries in Northern and Western Europe recorded negative APC values). Countries adopting asbestos bans reduced use rates about twice as fast as those not adopting bans. Turning points in use preceded bans. Change in asbestos use during 1970-1985 was a significant predictor of APC in mortality for pleural mesothelioma, with an adjusted R(2) value of 0.47 (p < 0.0001).

Conclusions: The observed disparities in global mesothelioma trends likely relate to country-to-country disparities in asbestos use trends.

Keywords: asbestos; asbestos-related diseases; ban; epidemiology; lung cancer; mesothelioma; mortality; occupational cancer; pleural mesothelioma.

Figure 1

Historical trends in use of asbestos from 1950 to 2003 grouped by status of national bans. Early-ban countries are countries that adopted bans in 1995 or before (n = 8); late-ban countries adopted bans from 1996 to 2006 (n = 14); no-ban countries, excluding the United States, did not adopt bans until 2007 (n = 8). Asbestos use (y-axis) is per capita yearly use (averages weighted by the sizes of national populations). The USGS (Virta 2006) database provides data only sparsely in 10-year intervals up to 1960, 5-year intervals from 1970–1995, and annually for 1996–2003. Straight lines connect available data.

Figure 2

Trend of MRs for male pleural mesothelioma in relation to change in asbestos use. See Table 1 for country codes. Circles have areas proportional to the sizes of male national populations; the smaller equal sizes indicate male national populations < 5,000,000. We defined the trend of MRs (y-axis) as APC, as calculated by the Joinpoint software. Bivariate relationships were examined by linear regression, weighted by the sizes of male national populations, and produced the following model: y = 0.011x + 2.022 (adjusted R² = 0.47, p < 0.0001).