Loading ...

TOPLINE:

Mesothelioma incidence and mortality declined more than 30% nationally from 1990 to 2023, with males experiencing reductions exceeding 40% while female rates decreased by < 10%. Female incidence increased in 20 states and mortality in 18, with occupational asbestos exposure accounting for more than 95% of deaths in 2023 and mortality-to-incidence ratios rising from 0.93 to 0.95.

METHODOLOGY:

• Although prior analyses have documented declining mesothelioma incidence and mortality, most lack state-level resolution or comprehensive burden measures such as disability-adjusted life years or mortality-to-incidence ratios, and few have systematically examined sex-specific subnational trends over extended periods.
• Researchers analyzed data from the Global Burden of Disease (GBD) 2023 database for mesothelioma at the national and state level in the US from 1990 to 2023, stratified by sex.
• Age-standardized incidence rates (ASIR), mortality rates (ASMR), disability-adjusted life years, and occupational-attributable fractions were obtained, with mortality-to-incidence ratios calculated to assess population-level survival.
• Occupational asbestos exposure was defined as the proportion of individuals aged ≥ 15 years exposed to asbestos during their lifetime, with data derived from GBD 2023 cause-of-death estimates, published literature, and International Labour Organization datasets.
• All rates are per 100,000 population and age-standardized using the GBD world standard derived from the 2012 United Nations Population Division’s World Population Prospects.

TAKEAWAY:

• Nationally, ASIR declined 33% (0.64 to 0.43 per 100,000) and ASMR declined 31% (0.60 to 0.41) from 1990 to 2023, with males experiencing ASIR reductions of 42% (1.21 to 0.70) and ASMR reductions of 41% (1.15 to 0.68). Female ASIR decreased nonsignificantly by 6.5% (0.24 to 0.22) and ASMR by 8.2% (0.23 to 0.21).
• The mortality-to-incidence ratios rose from 0.93 to 0.95 overall (2.15%) and increased among males (0.95 to 0.98), with Joinpoint regression showing an average annual percent change [AAPC] of 0.06% (P < .001) for the total population and AAPC of 0.08% (P < .001) for males, indicating no meaningful population-level survival improvement.
• Female incidence increased in 20 states with the largest AAPC increases in South Dakota (+0.51%/y) and Arkansas (+0.44%/y), whereas female mortality increased in 18 states with the largest AAPC increases in South Dakota (+0.43%/y), Arkansas (+0.42%/y), Mississippi (+0.39%/y), and West Virginia (+0.37%/y).
• Age-standardized disability-adjusted life years rates declined 40% overall from 1990 to 2023, though absolute disability-adjusted life years increased 14% (42,347 to 48,146), with males experiencing a 49% reduction and females showing a nonsignificant 13.4% change.

IN PRACTICE:

“While mesothelioma rates have declined nationally, progress has been uneven across sexes and states. Persistently high mortality-to-incidence ratios, rising female burden in multiple states, and substantial geographic heterogeneity emphasize the need for targeted surveillance, remediation of legacy asbestos, and investment in more effective therapies,” the authors of the study wrote.

SOURCE:

The study was led by Kyle Edwards, BS, and Chinmay Jani, MD, University of Miami Miller School of Medicine in Miami. The study was published in JCO Global Oncology.

LIMITATIONS:

Limitations may include reporting biases, reliance on modeled data, and differences varying by tumor grading, histologic subtype, and treatment protocols between specific periods. Changes in coding systems over time, particularly the International Classification of Diseases, Ninth Revision (ICD-9) to ICD-10 transition, may have introduced inconsistencies. Data heterogeneity across states, variation in death certification reliability, and regional differences in socioeconomic and regulatory environments contribute to variability. While the GBD employs redistribution algorithms for ill-defined diagnoses, residual misclassification likely persists. The study is observational and based on modeled estimates; causal inferences beyond risk factor associations cannot be established.

DISCLOSURES:

No disclosures or conflicts of interest statements are provided in the study.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.