Mesothelioma mortality in men: trends during 1977-2001 and projections for 2002-2016 in Spain

Abstract

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...

Incidence of mesothelioma in Lombardy, Italy: exposure to asbestos, time patterns and future projections

“…Projections of occurrence of MM (incidence or mortality) have been made in many countries in Europe (Britain, France, Germany, Italy, the Netherlands and Switzerland),3 Australia,24 25 New South Wales (Australia),26 Brazil,27 Canada and Quebec,28 Denmark,19 France,20 29 30 Germany,31 Italy,32 Veneto (Italy),33 Japan,34 35 the Netherlands,36 Spain,21 37 UK,22 38 39 South East England (UK),40 and USA 23 41–43. In several of those studies, projections regarded only men.…”

“…Definitions of mesothelioma differed between studies: some considered pleural cancer, some mesotheliomas of pleura plus other sites, relying on different versions of the International Classification of Disease (usually the Ninth and Tenth Revisions). The statistical model most often used to make projections was the Poisson age-cohort, either classical3 19 23 28 29 31 32 34 36 38 40–42 or Bayesian 33 37. Others used log-linear or generalised additive models relating incidence of MM or mortality to past consumption of asbestos 20 21 22 24 26 27 32 35 39 44.…”

Review of the effectiveness of predictive models for mesothelioma to identify lessons for asbestos-related policy

“…However, subsequent work comparing the observed cases against predictions found that the Bayesian enhanced APC model used by Pitarque et al (2008) underestimated observed mesotheliomas by 41 percent or 261 deaths (López-Abente et al 2013). …”

“…Other work has incorporated Bayesian statistical methods into APC models to make inferences from past knowledge to improve the fit of these models to identify the relative contribution of age, period and cohort on the risk of mesothelioma (Girardi et al 2014;Pitarque et al 2008). However, subsequent work comparing the observed cases against predictions found that the Bayesian enhanced APC model used by Pitarque et al (2008) The APC model has also been used to project future cases of mesothelioma using a method that does not require knowledge about asbestos exposure (Martínez Miranda et al 2015).…”

“…Compared with the earlier prediction of approximately 1000 deaths in the peak year of 2020 (Peto et al 1999), this enhanced model predicted a peak year of 2017 and 501 deaths (Segura et al 2003). However, the accuracy of this later method for predicting future mesotheliomas has not been assessed against observed data.Other work has incorporated Bayesian statistical methods into APC models to make inferences from past knowledge to improve the fit of these models to identify the relative contribution of age, period and cohort on the risk of mesothelioma (Girardi et al 2014;Pitarque et al 2008). However, subsequent work comparing the observed cases against predictions found that the Bayesian enhanced APC model used by Pitarque et al (2008) The APC model has also been used to project future cases of mesothelioma using a method that does not require knowledge about asbestos exposure (Martínez Miranda et al 2015).…”