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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 asbestos					Non-occup. Mesothelioma (inferred)	Total incuding all Mesothelioma
	Mesothelioma	Lung cancer	asbestosis	Ovarian and Larynx cancer	Total
United States	3,161	34,270	613	1,231	39,275	120	39,395
China	2,178	17,971	323	468	20,940	569	21,510
United Kingdom	2,837	14,056	209	934	18,036	27	18,063
Japan	1,449	14,529	320	293	16,591	57	16,648
Italy	1,699	12,810	101	785	15,394	28	15,422
Germany	1,729	12,613	199	701	15,242	36	15,278
France	1,546	10,083	257	595	12,481	27	12,508
India	1,976	4,018	482	661	7,136	429	7,565
Canada	648	5,031	61	156	5,896	15	5,911
Spain	494	4,137	71	230	4,932	20	4,952
Russia	624	3,716	29	407	4,776	68	4,843
Netherlands	639	3,845	13	167	4,664	7	4,671
Turkey	507	3,573	22	147	4,250	32	4,282
Australia	766	3,017	77	188	4,048	10	4,058
Brazil	691	2,417	64	268	3,441	87	3,528
Poland	234	2,510	12	156	2,913	17	2,930
Belgium	278	2,391	25	99	2,794	5	2,799
Vietnam	127	1,834	5	34	2,000	37	2,038
South Africa	280	1,338	117	89	1,823	16	1,839
South Korea	117	1,586	24	32	1,760	21	1,780
Iran	363	1,162	11	94	1,630	36	1,666
Argentina	202	1,255	26	97	1,580	17	1,597
Bangladesh	137	1,319	27	42	1,525	46	1,572
Thailand	222	1,255	4	41	1,522	34	1,556
Ukraine	309	825	7	203	1,344	20	1,364
Switzerland	203	1,015	3	52	1,273	4	1,276
Denmark	131	1,061	10	60	1,263	2	1,265
Mexico	323	690	24	86	1,123	44	1,167
Sweden	173	899	13	73	1,157	4	1,161
Myanmar	166	798	3	141	1,108	23	1,131
Greece	79	967	2	46	1,093	5	1,098
Indonesia	337	556	15	76	984	103	1,088
Austria	118	769	3	52	942	4	946
Pakistan	158	537	31	92	819	54	873
Taiwan	52	677	14	13	756	10	766
Finland	103	602	20	35	760	2	763
Croatia	67	637	6	35	745	2	747
Norway	80	527	8	28	643	2	645
Philippines	105	471	7	22	605	38	643
New Zealand	97	478	10	23	609	2	610
Portugal	63	460	6	27	556	4	560
Global	27,612	181,450	3,495	9,765	222,321	2,596	224,918

(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 asbestos					Non-occup. Mesothelioma (inferred)	Total incuding all Mesothelioma
	Mesothelioma	Lung cancer	asbestosis	Ovarian and Larynx cancer	Total
United Kingdom	4.34	21.50	0.32	1.43	27.59	0.04	27.63
Netherlands	3.73	22.43	0.07	0.97	27.21	0.04	27.25
Italy	2.81	21.17	0.17	1.30	25.44	0.05	25.49
Belgium	2.45	21.04	0.22	0.87	24.58	0.04	24.62
Greenland	1.18	21.62	0.04	0.39	23.22	0.04	23.26
Denmark	2.30	18.54	0.18	1.05	22.06	0.04	22.10
Andorra	4.12	15.96	0.21	0.66	20.95	0.04	20.99
France	2.38	15.53	0.40	0.92	19.22	0.04	19.26
Germany	2.11	15.37	0.24	0.85	18.58	0.04	18.62
Croatia	1.58	15.10	0.14	0.83	17.66	0.04	17.70
Australia	3.18	12.52	0.32	0.78	16.80	0.04	16.84
Malta	2.18	13.51	0.15	0.74	16.58	0.04	16.62
Canada	1.78	13.85	0.17	0.43	16.23	0.04	16.27
Switzerland	2.42	12.12	0.03	0.62	15.19	0.04	15.23
Finland	1.88	10.94	0.37	0.63	13.81	0.04	13.85
New Zealand	2.14	10.50	0.22	0.51	13.37	0.04	13.41
Japan	1.15	11.56	0.25	0.23	13.20	0.05	13.25
Slovenia	1.43	10.35	0.23	0.62	12.63	0.04	12.67
Luxembourg	1.36	10.64	0.05	0.53	12.58	0.04	12.62
Norway	1.52	10.03	0.15	0.53	12.24	0.04	12.27
United States	0.98	10.61	0.19	0.38	12.16	0.04	12.20
Sweden	1.75	9.09	0.13	0.74	11.71	0.04	11.75
Austria	1.35	8.85	0.04	0.60	10.84	0.04	10.88
Cyprus	1.32	8.91	0.10	0.45	10.78	0.04	10.82
Spain	1.06	8.90	0.15	0.49	10.61	0.04	10.65
Greece	0.73	8.89	0.02	0.42	10.06	0.04	10.10
Iceland	1.13	8.45	0.04	0.39	10.02	0.04	10.05
Ireland	0.95	8.37	0.08	0.35	9.75	0.03	9.79
Poland	0.60	6.50	0.03	0.40	7.54	0.04	7.58
Virgin Islands, U.S.	0.97	5.19	0.05	0.56	6.77	0.05	6.82
Bermuda	0.56	4.55	0.01	0.33	5.44	0.04	5.48
Turkey	0.64	4.50	0.03	0.19	5.36	0.04	5.40
Portugal	0.60	4.39	0.05	0.26	5.31	0.04	5.35
Hungary	0.36	4.48	0.01	0.25	5.10	0.04	5.15
Armenia	0.60	3.81	0.01	0.31	4.72	0.04	4.76
Singapore	0.43	4.09	0.01	0.10	4.62	0.04	4.65
Israel	0.55	3.79	0.02	0.26	4.62	0.03	4.65
Czech Republic	0.44	3.89	0.01	0.25	4.60	0.04	4.64
Serbia	0.36	3.86	0.01	0.19	4.42	0.04	4.46
Latvia	0.43	3.58	0.01	0.37	4.38	0.04	4.43
Uruguay	0.34	3.72	0.02	0.20	4.28	0.04	4.32
Global	0.37	2.45	0.05	0.13	3.00	0.04	3.04

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

Country	Attributed to occupational exposure to asbestos					Non-occup. Mesothelioma (inferred)	Total incuding all Mesothelioma
	Mesothelioma	Lung cancer	asbestosis	Ovarian and Larynx cancer	Total
Greenland	1.85	33.49	0.08	0.58	36.00	0.03	36.03
United Kingdom	2.52	11.99	0.17	0.78	15.45	0.03	15.49
Netherlands	2.16	12.69	0.04	0.53	15.42	0.03	15.45
Belgium	1.39	11.56	0.11	0.45	13.51	0.03	13.55
Denmark	1.32	10.16	0.10	0.57	12.15	0.03	12.18
Italy	1.38	9.44	0.07	0.56	11.45	0.03	11.49
Australia	2.15	8.34	0.20	0.50	11.19	0.03	11.23
Andorra	2.23	8.28	0.10	0.31	10.91	0.03	10.94
France	1.34	8.53	0.19	0.46	10.52	0.03	10.55
Canada	1.12	8.74	0.10	0.26	10.23	0.03	10.27
Croatia	0.91	8.28	0.07	0.45	9.70	0.03	9.74
Malta	1.21	7.27	0.08	0.40	8.96	0.03	9.00
New Zealand	1.45	7.02	0.15	0.33	8.96	0.03	8.99
Luxembourg	0.95	7.23	0.04	0.35	8.56	0.03	8.59
Switzerland	1.40	6.80	0.02	0.32	8.55	0.03	8.58
Germany	1.01	7.02	0.10	0.38	8.51	0.03	8.54
United States	0.66	7.09	0.12	0.25	8.12	0.03	8.15
Lesotho	0.98	5.96	0.60	0.41	7.95	0.04	7.98
Cyprus	0.96	6.44	0.07	0.31	7.78	0.03	7.82
Norway	0.97	6.24	0.10	0.31	7.63	0.03	7.65
Ireland	0.72	6.27	0.06	0.26	7.32	0.03	7.35
Iceland	0.81	5.94	0.03	0.27	7.05	0.03	7.08
Slovenia	0.83	5.71	0.12	0.34	7.00	0.03	7.03
Finland	0.99	5.42	0.18	0.31	6.89	0.03	6.92
Turkey	0.72	5.38	0.03	0.22	6.36	0.04	6.40
Sweden	0.94	4.57	0.07	0.35	5.93	0.03	5.96
Austria	0.77	4.83	0.02	0.31	5.93	0.03	5.96
Bermuda	0.58	4.85	0.01	0.35	5.79	0.04	5.83
Spain	0.60	4.73	0.07	0.25	5.65	0.03	5.68
South Africa	0.81	4.16	0.36	0.28	5.61	0.03	5.65
Swaziland	0.67	3.88	0.41	0.23	5.19	0.03	5.22
Botswana	0.70	3.55	0.37	0.22	4.84	0.04	4.87
Poland	0.40	4.11	0.02	0.26	4.78	0.04	4.81
Greece	0.37	4.14	0.01	0.18	4.71	0.03	4.74
Guam	0.33	4.09	0.04	0.07	4.54	0.04	4.57
Japan	0.47	3.86	0.09	0.08	4.50	0.03	4.53
Virgin Islands, U.S.	0.61	3.11	0.03	0.33	4.09	0.04	4.13
Israel	0.50	3.30	0.02	0.22	4.03	0.03	4.07
Brunei	0.37	3.45	0.01	0.19	4.02	0.04	4.05
Singapore	0.36	3.55	0.01	0.08	4.00	0.03	4.03
Bahrain	0.52	3.01	0.21	0.14	3.89	0.04	3.93
Global	0.42	2.9	0.06	0.16	3.54	0.04	3.58

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