Burden of Mesothelioma Deaths by National Income Category: Current Status and Future Implications

Abstract

Background: This study compares estimates of the global-level mesothelioma burden with a focus on how existing national mortality data were utilized and further assesses the interrelationship of country-level mesothelioma burden and asbestos use with national income status. Methods: Country-level mesothelioma deaths in the WHO Mortality Database as of December 2019 were analyzed by national income category of countries in terms of data availability and reliability. Numbers of mesothelioma deaths from the study of Odgerel et al. were reanalyzed to assess country-level mesothelioma death burdens by national income status. Results: Among 80 high-income countries, 54 (68%) reported mesothelioma to the WHO and 26 (32%) did not, and among 60 upper middle-income countries, the respective numbers (proportions) were 39 (65%) countries and 21 (35%) countries, respectively. In contrast, among 78 low- and lower middle-income countries, only 11 (14%) reported mesothelioma deaths while 67 (86%) did not. Of the mesothelioma deaths, 29,854 (78%) were attributed to high- and upper middle-income countries, and 8534 (22%) were attributed to low- and lower middle- income countries. Conclusions: The global mesothelioma burden, based on reported numbers, is currently shouldered predominantly by high-income countries; however, mesothelioma burdens will likely manifest soon in upper middle-income and eventually in low and lower middle-income countries.

Keywords: asbestos; burden of disease; deaths; developing countries; estimation; global health; mesothelioma; national income.

Figure 1

Trend over time in number of countries reporting mesothelioma deaths to the WHO by national income category ¹ and data reliability ².HIC: High income countries; UMIC: Upper middle-income countries; LMIC: Lower middle- and low-income countries combined (See Table 2 and text for exact definition of national income category). ¹ All countries reporting mesothelioma deaths to the WHO. ² Of ¹, countries reporting data judged to be “reliable” according to Odgerel et al. [13].

Figure 2

Number of Reported/Estimated Annual Mesothelioma Deaths by Countries According to National Income Category. A: High income countries (N = 80), B: Upper middle-income countries (N = 60); C: Lower middle income and low-income countries combined (N = 78). See Table 2 and text for exact definition of national income category. Estimated numbers are from Odgerel et al 2017 [13], which the present study (for the first time) grouped by national income category. Countries are listed by three-letter codes, e.g., USA for the United States. Table S1 lists all codes used. “D < 10” indicates the group of countries with fewer than 10 deaths (either reported or estimated) for which the aggregate number of deaths is shown. Table S2 lists these countries.

Figure 3

Global Trend Over Time in Asbestos Use of the 3 Country Groups based on National Income Category. HIC: High income countries (N = 54), UMIC: Upper middle-income countries (N = 51); LMIC: Lower middle income and low-income countries combined (N = 57). See Table 2 and text for exact definition of national income category. USGS reported world asbestos consumption with 10- and 5- year interval during 1920–1970 and 1975–1995, respectively, and every single year since 1995.

Figure 4

Cumulative Use of Asbestos (metric tonnes) Since 1980 by Country and National Income Category. HIC: High income countries, UMIC: Upper middle-income countries; LMIC: Lower middle income and low-income countries combined. See Table 2 and text for exact definition of national income category. Only top 10 countries in each national income category that recorded the highest cumulative asbestos use since 1980 are shown. Countries that have banned asbestos are shown in bold with the year of banning in brackets.