Must countries shoulder the burden of mesothelioma to ban asbestos? A global assessment

Abstract

Introduction: Mesothelioma is a key asbestos-related disease (ARD) but can be difficult to diagnose. Countries presumably ban asbestos to reduce future ARD burdens, but it is unknown if countries ban asbestos as a consequence of ARD burdens. We assessed if and to what extent mesothelioma burden has an impact on a country banning asbestos and obtaining targets for preventative strategies.

Methods: We analysed the status of asbestos ban and mesothelioma burden during 1990-2019 in 198 countries. We assessed mesothelioma burden by age-adjusted mortality rates (MRs) estimated by the Global Burden of Disease Study (GBD) and mesothelioma identification by the WHO mortality database. For GBD-estimated mesothelioma MR, the pre-ban period in the asbestos-banned countries was compared with the 1990-2019 period in the not-banned countries. For mesothelioma identification, the 1990-2019 period was applied to both banned and not-banned countries.

Results: The association of mesothelioma MR with ban status increased as the ban year approached. Logistic regression analyses showed that the odds of a country banning asbestos increased 14.1-fold (95% CI 5.3 to 37.9) for mesothelioma identification combined with a 26% (12% to 42%) increase per unit increase of mesothelioma MR (one death per million per year) during the period 1-5 year before ban (model p<0.0001).

Conclusion: Mesothelioma burden had an impact on, and together with its identification, explained the banning of asbestos in many countries. Asbestos-banned countries likely learnt lessons from their historical policies of using asbestos because mesothelioma burden and identification follow historical asbestos use. Prevention targets for ARD elimination should combine asbestos ban with mesothelioma identification.

Keywords: Epidemiology; Prevention strategies; Public Health.

Figure 1

Global Burden of Disease study (GDB)-estimated age-adjusted mortality rates (MR) of mesothelioma in countries grouped by the status of asbestos ban and mesothelioma identification in 198 countries. (1) Six ‘early-banned’ countries that banned asbestos in or before 1990, that is, Austria, Denmark, Iceland, Norway, Sweden and Switzerland, are precluded from this analysis and are analysed separately in table 4. See Methods for full explanation. The outlier countries in the respective country groups indicated by points are as follows: ‘Banned and identified’: the UK (19.7), Australia (18.8); ‘banned and not-identifed’: Monaco (10.1), Algeria (0.5); "not-banned and identified’: Amenia (8.0); ‘not-banned and not-identified’): Andorra (16.4), Lesotho (13.7), Namibia (12.7), Eswatini (11.9), Botswana (9.9), Greenland (9.2), San Marinho (8.3). Number within brackets indicate values of mesothelioma MR. See Methods for full definition of asbestos ban and mesothelioma identification. This box plot shows the 25th percentile (Q1; bottom of box), median (Q2; horizontal line in box) and 75th percentile (Q3; top of box). Outliers outside the interquartile range are displayed as ‘whisker’ lines of points.