Objectives: To evaluate mesothelioma death trends in Spain and to predict the number of future cases of mesothelioma. Methods: After descriptive analysis of mesothelioma mortality data, an age-period-cohort model was applied to estimate future mesothelioma deaths. Results: From 1977to 2001, 1928 men over 35 years of age died of mesothelioma in Spain. Projections indicate that 1321 men are expected to die from mesothelioma between 2007 and 2016. Conclusion: It is expected that mesothelioma deaths will increase at least until 2016. Available data do not allow prediction of the year when mortality will start to decrease.Exposure to asbestos is the main cause of mesothelioma. 1The number of mesothelioma deaths reflects past exposure to asbestos and can be used to make future projections. Increases in mesothelioma deaths in recent years have been reported in several countries and future projections indicate a continuation of this increase in mortality in the future even though use of asbestos has been banned in most industrialised countries. 2-6Spain was not an asbestos producing country, but around 800 companies used 2.6 million tonnes of asbestos between 1900 and 2000 (chrysotile was 90% of the total).7 Use was especially high between 1960 and the mid 1980s, reaching its peak in 1973 (113 000 tonnes).7 Asbestos regulations were first introduced in 1984 and asbestos was banned in 2001; residual activities involving asbestos exposure were regulated in 2006. 8 An estimate of occupational exposure to asbestos in Spain indicates that 56 600 workers were exposed to asbestos in the late 1990s, mainly in the construction industry. The main aim of this study was to analyse trends in mesothelioma mortality and to predict the number of deaths due to mesothelioma in men in the future in Spain. This estimation may be useful for planning and supporting active medical surveillance programs that aim to increase awareness of asbestos exposure in Spain, encourage the discovery of unregistered formerly exposed workers, and identify and compensate for occupational diseases when necessary. METHODSPleural cancer mortality and mesothelioma mortality are acknowledged indicators of exposure to asbestos. Tables giving the number of pleural neoplasm deaths (ICD-9: 163) for men and women between 1977 and 2001 have been provided by the Centro Nacional de Epidemiología 10 arranged in five 5-year periods (1977-1981, 1982-1986, 1987-1991, 1992-1996 and 1997-2001) and nine 5-year age groups (35-39 to 75-79 years of age). To avoid strata without deaths, considering that mesothelioma with less than 20 years' latency 11 is only rarely observed and assuming earliest entry to industrial work at age 15, the lowest age group we used was 35-39 years of age. Mesothelioma deaths in people aged 80 or older were excluded from the analysis due to the lack of accuracy in determining the cause of death. 12The calendar periods and the age groups examined involved 13 overlapping birth cohorts, defined by their central year of birth beginning in 1902 and e...