Global Asbestos Mortality Data  

by David Allen & Laurie Kazan-Allen

 

 

In mid-September, 2017, a 77-page article entitled: Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990–2016: a systematic analysis for the Global Burden of Disease (GBD) Study 2016 was featured in The Lancet.1 The paper is credited to GBD Risk Factors Collaborators (listed at the end of the Lancet article), comprising – at a rough count – around 640 individuals affiliated to more than 460 institutions. The “comprehensive assessment of risk factor exposure and attributable burden of disease” undertaken by the study includes mortality caused by occupational asbestos exposures.

While the breadth of the research covering so many countries, categories and factors is staggering, the failure to include data on environmental asbestos exposures is disappointing, and possible underestimations of asbestos-caused occupational mortality compared with other studies a worry.2 In a paper entitled: Comparative Analysis of the Burden of Injury and Illness at Work in Selected Countries and Regions published in June 2017, it was concluded that the global death rate from all asbestos-related exposures could exceed 300,000,3 whereas our reading of the GBD data produces a figure of just under 225,000.

Despite the above reservations, an analysis of the GBD study’s asbestos data is both informative and timely as the global ban asbestos debate intensifies; this may be accomplished by interrogation of the GBD 2016 Database held on the IHME (Institute for Health Metrics and Evaluation) website, maintained by the University of Washington. Results may be viewed online, downloaded as CSV files, or “visualized” on a separate IHME page.

Search results from the database are tailored to fit options selected from a number of drop-down check-box lists. With respect to asbestos-related diseases (ARDs), the primary list to select from is labelled “Context.” Seven options are listed, but for the tables included in this article we used only Risk and Cause options (selected individually in different searches). Selection of Risk causes another drop-down list to appear labelled “Risk”; from this we only ever selected the Occupational exposure to asbestos option. We looked at data for 2016 but comparative data – ranging from 1990 to 2016 – can also be retrieved. (Detailed chains of options chosen to populate the three tables referenced by this article are shown in the Appendix.)

Table 1 shows mortality from occupationally caused ARDs plus a small inferred contribution of non-occupationally caused mesothelioma – the latter obtained by choosing mesothelioma as a “Cause” then subtracting from this “total mesothelioma” the figure obtained for occupationally caused mesothelioma.

The thing that stands out from this table is the great disparity between the ratios of lung cancer to mesothelioma across the 150 countries included in the study; globally the factor is 6.6. If this factor were to be applied to the inferred figure for environmentally caused mesothelioma then the ARD mortality total would be raised to around 242,000.

Table 2 shows the mortality rate (per 100,000 population) for all age groups, while Table 3 shows the mortality rates weighted by being “age-standardized.”

Abridged versions of the three tables (the top 40 countries with respect to measures of ARD mortality – plus a final line showing the global mortality measure) are shown below; however, full PDF versions of the tables can obtained by clicking the following links:

Table 1 pdf   |   Table 2 pdf   |   Table 3 pdf

Table 1. ARD Mortality by Country and Disease (from GBD Study 2016)

 
Country
 
Attributed to occupational exposure to asbestosNon-occup.
Mesothelioma
(inferred)
Total
incuding all
Mesothelioma
MesotheliomaLung cancerasbestosisOvarian and
Larynx cancer
Total
United States3,16134,2706131,23139,27512039,395
China2,17817,97132346820,94056921,510
United Kingdom2,83714,05620993418,0362718,063
Japan1,44914,52932029316,5915716,648
Italy1,69912,81010178515,3942815,422
Germany1,72912,61319970115,2423615,278
France1,54610,08325759512,4812712,508
India1,9764,0184826617,1364297,565
Canada6485,031611565,896155,911
Spain4944,137712304,932204,952
Russia6243,716294074,776684,843
Netherlands6393,845131674,66474,671
Turkey5073,573221474,250324,282
Australia7663,017771884,048104,058
Brazil6912,417642683,441873,528
Poland2342,510121562,913172,930
Belgium2782,39125992,79452,799
Vietnam1271,8345342,000372,038
South Africa2801,338117891,823161,839
South Korea1171,58624321,760211,780
Iran3631,16211941,630361,666
Argentina2021,25526971,580171,597
Bangladesh1371,31927421,525461,572
Thailand2221,2554411,522341,556
Ukraine30982572031,344201,364
Switzerland2031,0153521,27341,276
Denmark1311,06110601,26321,265
Mexico32369024861,123441,167
Sweden17389913731,15741,161
Myanmar16679831411,108231,131
Greece799672461,09351,098
Indonesia33755615769841031,088
Austria1187693529424946
Pakistan158537319281954873
Taiwan52677141375610766
Finland10360220357602763
Croatia676376357452747
Norway805278286432645
Philippines10547172260538643
New Zealand9747810236092610
Portugal634606275564560
Global27,612181,4503,4959,765222,3212,596224,918

(In the above table figures are rounded to integral values unless the original figure was less than one; in the latter case one decimal place is shown.)

Table 2. ARD Mortality Rate by Country and Disease (from GBD Study 2016)

 
Country
 
Attributed to occupational exposure to asbestosNon-occup.
Mesothelioma
(inferred)
Total
incuding all
Mesothelioma
MesotheliomaLung cancerasbestosisOvarian and
Larynx cancer
Total
United Kingdom4.3421.500.321.4327.590.0427.63
Netherlands3.7322.430.070.9727.210.0427.25
Italy2.8121.170.171.3025.440.0525.49
Belgium2.4521.040.220.8724.580.0424.62
Greenland1.1821.620.040.3923.220.0423.26
Denmark2.3018.540.181.0522.060.0422.10
Andorra4.1215.960.210.6620.950.0420.99
France2.3815.530.400.9219.220.0419.26
Germany2.1115.370.240.8518.580.0418.62
Croatia1.5815.100.140.8317.660.0417.70
Australia3.1812.520.320.7816.800.0416.84
Malta2.1813.510.150.7416.580.0416.62
Canada1.7813.850.170.4316.230.0416.27
Switzerland2.4212.120.030.6215.190.0415.23
Finland1.8810.940.370.6313.810.0413.85
New Zealand2.1410.500.220.5113.370.0413.41
Japan1.1511.560.250.2313.200.0513.25
Slovenia1.4310.350.230.6212.630.0412.67
Luxembourg1.3610.640.050.5312.580.0412.62
Norway1.5210.030.150.5312.240.0412.27
United States0.9810.610.190.3812.160.0412.20
Sweden1.759.090.130.7411.710.0411.75
Austria1.358.850.040.6010.840.0410.88
Cyprus1.328.910.100.4510.780.0410.82
Spain1.068.900.150.4910.610.0410.65
Greece0.738.890.020.4210.060.0410.10
Iceland1.138.450.040.3910.020.0410.05
Ireland0.958.370.080.359.750.039.79
Poland0.606.500.030.407.540.047.58
Virgin Islands, U.S.0.975.190.050.566.770.056.82
Bermuda0.564.550.010.335.440.045.48
Turkey0.644.500.030.195.360.045.40
Portugal0.604.390.050.265.310.045.35
Hungary0.364.480.010.255.100.045.15
Armenia0.603.810.010.314.720.044.76
Singapore0.434.090.010.104.620.044.65
Israel0.553.790.020.264.620.034.65
Czech Republic0.443.890.010.254.600.044.64
Serbia0.363.860.010.194.420.044.46
Latvia0.433.580.010.374.380.044.43
Uruguay0.343.720.020.204.280.044.32
Global0.372.450.050.133.000.043.04

Table 3. ARD Age-Standardized Mortality Rate by Country and Disease (from GBD Study 2016)

 
Country
 
Attributed to occupational exposure to asbestosNon-occup.
Mesothelioma
(inferred)
Total
incuding all
Mesothelioma
MesotheliomaLung cancerasbestosisOvarian and
Larynx cancer
Total
Greenland1.8533.490.080.5836.000.0336.03
United Kingdom2.5211.990.170.7815.450.0315.49
Netherlands2.1612.690.040.5315.420.0315.45
Belgium1.3911.560.110.4513.510.0313.55
Denmark1.3210.160.100.5712.150.0312.18
Italy1.389.440.070.5611.450.0311.49
Australia2.158.340.200.5011.190.0311.23
Andorra2.238.280.100.3110.910.0310.94
France1.348.530.190.4610.520.0310.55
Canada1.128.740.100.2610.230.0310.27
Croatia0.918.280.070.459.700.039.74
Malta1.217.270.080.408.960.039.00
New Zealand1.457.020.150.338.960.038.99
Luxembourg0.957.230.040.358.560.038.59
Switzerland1.406.800.020.328.550.038.58
Germany1.017.020.100.388.510.038.54
United States0.667.090.120.258.120.038.15
Lesotho0.985.960.600.417.950.047.98
Cyprus0.966.440.070.317.780.037.82
Norway0.976.240.100.317.630.037.65
Ireland0.726.270.060.267.320.037.35
Iceland0.815.940.030.277.050.037.08
Slovenia0.835.710.120.347.000.037.03
Finland0.995.420.180.316.890.036.92
Turkey0.725.380.030.226.360.046.40
Sweden0.944.570.070.355.930.035.96
Austria0.774.830.020.315.930.035.96
Bermuda0.584.850.010.355.790.045.83
Spain0.604.730.070.255.650.035.68
South Africa0.814.160.360.285.610.035.65
Swaziland0.673.880.410.235.190.035.22
Botswana0.703.550.370.224.840.044.87
Poland0.404.110.020.264.780.044.81
Greece0.374.140.010.184.710.034.74
Guam0.334.090.040.074.540.044.57
Japan0.473.860.090.084.500.034.53
Virgin Islands, U.S.0.613.110.030.334.090.044.13
Israel0.503.300.020.224.030.034.07
Brunei0.373.450.010.194.020.044.05
Singapore0.363.550.010.084.000.034.03
Bahrain0.523.010.210.143.890.043.93
Global0.422.90.060.163.540.043.58

October 12, 2017

Appendix

In choosing IHME search options, it’s important4 to ensure default options are unchecked; if it is intended to download data it is best to initially click the “Search” button – to ensure only desired options are in play – before finally clicking the “Download” button.

Table 1; main data:
Context/Risk | Risk/Occupational exposure to asbestos | Age/All ages| | Metric/Number |
Measure/Deaths | Sex/Both | Cause/Tracheal, bronchus, and lung cancer/Mesothelioma/
Larynx cancer/Ovarian cancer/Asbestosis | Base: Single | Year/2016 |
Location/ (First we selected all, then unchecked options that were not countries)

Mesothelioma alone:
As above except select: Context/Cause (the Risk check-list box will not appear) | Cause/Mesothelioma

Table 2:
As for table 1 except select: Metric/Rate

Table 3:
As for table 2 except select: Age/Age-standardized

_______

1 GBD Risk Factors Collaborators. Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. September 16, 2017.
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)32366-8/abstract

2 Odgerel CO, Takahashi K, et al. Estimation of the global burden of mesothelioma deaths from incomplete national mortality data. September 2, 2017.
http://oem.bmj.com/content/early/2017/09/02/oemed-2017-104298.full

3 Takala J, Hämäläinen P. et al. Comparative Analysis of the Burden of Injury and Illness at Work in Selected Countries and Regions. June 14, 2017.
http://www.omfi.hu/cejoem/Volume23/Vol23No1-2/23_1-2_Article_01.pdf

 

 

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