Elsevier

The Lancet

Volume 369, Issue 9564, 10–16 March 2007, Pages 844-849
The Lancet

Articles
Ecological association between asbestos-related diseases and historical asbestos consumption: an international analysis

https://doi.org/10.1016/S0140-6736(07)60412-7Get rights and content

Summary

Background

The potential for a global epidemic of asbestos-related diseases is a growing concern. Our aim was to assess the ecological association between national death rates from diseases associated with asbestos and historical consumption of asbestos.

Methods

We calculated, for all countries with data, yearly age-adjusted mortality rates by sex (deaths per million population per year) for each disease associated with asbestos (pleural, peritoneal, and all mesothelioma, and asbestosis) in 2000–04 and mean per head asbestos consumption (kg per person per year) in 1960–69. We regressed death rates for the specified diseases against historical asbestos consumption, weighted by the size of sex-specific national populations.

Findings

Historical asbestos consumption was a significant predictor of death for all mesothelioma in both sexes (adjusted R2=0·74, p<0·0001, 2·4-fold [95% CI 2·0–2·9] mortality increase was predicted per unit consumption increase for men; 0·58, p<0·0001, and 1·6-fold [1·4–1·9] mortality increase was predicted for women); for pleural mesothelioma in men (0·29, p=0·0015, 1·8-fold [1·3–2·5]); for peritoneal mesothelioma in both sexes (0·54, p<0·0001, 2·2-fold [1·6–2·9] for men, 0·35, p=0·0008, and 1·4-fold for women [1·2–1·6]); and for asbestosis in men (0·79, p<0·0001, 2·7-fold [2·2–3·4]). Linear regression lines consistently had intercepts near zero.

Interpretation

Within the constraints of an ecological study, clear and plausible associations were shown between deaths from the studied diseases and historical asbestos consumption, especially for all mesothelioma in both sexes and asbestosis in men. Our data strongly support the recommendation that all countries should move towards eliminating use of asbestos.

Introduction

The possibility of a global epidemic of asbestos-related diseases is a cause for widespread concern. Such diseases include asbestosis and many types of mesothelioma. Selikoff and colleagues1, 2 have urged caution about the use of asbestos since the 1960s, and in more recent years, Peto and colleagues3, 4 have predicted a drastic increase in future mesothelioma deaths in the UK3 and Europe.4 Further investigations showed close agreement between projected and actual numbers on one hand, and tapering5 or deceleration6 of the mesothelioma epidemic on the other. Statistical projections of mesothelioma rates suggest substantial increases in many countries.7, 8, 9, 10

The worldwide burden of diseases associated with asbestos has also been estimated; the yearly number of asbestos-related cancer deaths in workers could be 100 000–140 000.11 5–7% of lung cancer cases might be attributable to occupational asbestos exposure,11, 12 although such estimates would vary with the amount of tobacco consumed. At the International Expert Meeting on Asbestos, Asbestosis, and Cancer in 1997, delegates discussed such a worldwide epidemic, and agreed that every year, 20 000 cases of lung cancer and 10 000 cases of mesothelioma in west Europe, North America, Japan, and Australia could be due to asbestos.13 The International Labour Organisation (ILO) and WHO jointly announced the elimination of diseases associated with asbestos as a priority for collaboration. ILO has expressed much concern about an evolving epidemic of these diseases, especially since disease is seen only after a long latent period (30–40 years),14 and has adopted a resolution to promote a worldwide asbestos ban.15

The extent of asbestos exposure around the world is difficult to estimate, mainly because quantified measurement data are few. To the present day, about 20–40% of adult men are thought to have held jobs that could have entailed some asbestos exposure.13, 16 However, attempts to estimate the proportion of exposed people in populations are generally hampered by the absence of reliable estimates of exposure for people with occupational asbestos exposure, for women's exposure, and for environmental exposure. A wide disparity in exposure status of populations is likely, and would be affected by the timeframe studied, and be different depending on the country. The volume of asbestos consumed per head can act as a surrogate for the exposure level of a population and ecological associations between exposure rates and disease rates can be measured. The volume of asbestos consumption over time was used to characterise various populations.11, 17 These indices suggest that people living in developing countries are faced with increasing exposure to asbestos.11, 17 Preliminary investigations for mesothelioma have produced plausible findings for its association with amount of asbestos consumption per head, although these investigations were limited by the small number of countries assessed, and by studying only mesothelioma.12, 18, 19 The aim of our study was therefore to investigate the ecological association between national mortality rates from diseases associated with asbestos and historical asbestos consumption in the respective countries.

Section snippets

Methods

The diseases associated with asbestos that we studied were: pleural mesothelioma (C45·0, as classified by the International Classification of Diseases, 10th revision [ICD-10]); peritoneal mesothelioma (C45·1, ICD-10); all mesothelioma; and asbestosis (J61, ICD-10). All mesothelioma was defined as mesothelioma (C45, ICD-10) as an independent category or composite of all or any of its subcategories—ie, pleural (C45·0), peritoneal (C45·1), pericardial (C45·2), other sites (C45·7), and unspecified

Results

The figure shows scatter plots of national data for the diseases associated with asbestos (male sex had the highest adjusted R2 value and was therefore chosen for presentation in the figure). A positive linear relation between historical asbestos consumption and log-transformed death rates can clearly be seen. The sex-specific association of individual asbestos-related diseases was expressed as a linear regression model in the table, with the parameters intercept B0 and slope B1, and adjusted R2

Discussion

We recorded that recent national death rates from diseases associated with asbestos were closely related to historical asbestos consumption rates in 1960–69. The ecological association was consistently positive for all studied diseases in men. In women, significantly positive ecological relations between asbestos consumption and deaths from associated diseases were recorded for peritoneal and all mesothelioma, but not for pleural mesothelioma or asbestosis. The associations were especially

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