title: Ecological association between asbestos-related diseases and historical asbestos consumption: an international analysis.
abstract: BACKGROUND
  The potential for a global epidemic of asbestos-related diseases is a growing concern. Our aim was to assess the ecological association between national death rates from diseases associated with asbestos and historical consumption of asbestos.
  
  
  METHODS
  We calculated, for all countries with data, yearly age-adjusted mortality rates by sex (deaths per million population per year) for each disease associated with asbestos (pleural, peritoneal, and all mesothelioma, and asbestosis) in 2000-04 and mean per head asbestos consumption (kg per person per year) in 1960-69. We regressed death rates for the specified diseases against historical asbestos consumption, weighted by the size of sex-specific national populations.
  
  
  RESULTS
  Historical asbestos consumption was a significant predictor of death for all mesothelioma in both sexes (adjusted R2=0.74, p<0.0001, 2.4-fold [95% CI 2.0-2.9] mortality increase was predicted per unit consumption increase for men; 0.58, p<0.0001, and 1.6-fold [1.4-1.9] mortality increase was predicted for women); for pleural mesothelioma in men (0.29, p=0.0015, 1.8-fold [1.3-2.5]); for peritoneal mesothelioma in both sexes (0.54, p<0.0001, 2.2-fold [1.6-2.9] for men, 0.35, p=0.0008, and 1.4-fold for women [1.2-1.6]); and for asbestosis in men (0.79, p<0.0001, 2.7-fold [2.2-3.4]). Linear regression lines consistently had intercepts near zero.
  
  
  CONCLUSIONS
  Within the constraints of an ecological study, clear and plausible associations were shown between deaths from the studied diseases and historical asbestos consumption, especially for all mesothelioma in both sexes and asbestosis in men. Our data strongly support the recommendation that all countries should move towards eliminating use of asbestos.
authors.affiliation: Department of Environmental Epidemiology, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Yahatanishiku, Kitakyushu, 807-8555, Japan.
authors.forename: Ro-Ting
authors.initials: RT
authors.lastname: Lin
authors.affiliation: Department of Environmental Epidemiology, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Yahatanishiku, Kitakyushu, 807-8555, Japan. Electronic address: ktaka@med.uoeh-u.ac.jp.
authors.forename: Ken
authors.initials: K
authors.lastname: Takahashi
authors.affiliation: Department of Epidemiology and Biostatistics, Finnish Institute of Occupational Health, Helsinki, Finland.
authors.forename: Antti
authors.initials: A
authors.lastname: Karjalainen
authors.affiliation: Department of Environmental Epidemiology, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Yahatanishiku, Kitakyushu, 807-8555, Japan.
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Hoshuyama
authors.affiliation: Department of Environmental Epidemiology, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Yahatanishiku, Kitakyushu, 807-8555, Japan.
authors.forename: Donald
authors.initials: D
authors.lastname: Wilson
authors.affiliation: Department of Environmental Epidemiology, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Yahatanishiku, Kitakyushu, 807-8555, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Kameda
authors.affiliation: Institute of Occupational Medicine and Industrial Hygiene, College of Public Health, National Taiwan University, Taiwan.
authors.forename: Chang-Chuan
authors.initials: CC
authors.lastname: Chan
authors.affiliation: Centre for Health Policy Research and Development, National Health Research Institutes, Taiwan.
authors.forename: Chi-Pang
authors.initials: CP
authors.lastname: Wen
authors.affiliation: Japan Occupational Safety and Health Resource Centre, Tokyo.
authors.forename: Sugio
authors.initials: S
authors.lastname: Furuya
authors.affiliation: Department of Work Systems and Health, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Japan.
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Higashi
authors.affiliation: Department of Biostatistics, School of Public Health, University of North Carolina at Chapel Hill, NC, USA.
authors.forename: Lung-Chang
authors.initials: LC
authors.lastname: Chien
authors.affiliation: Department of Environmetrics and Biometrics, Research Institute for Radiation Biology and Medicine, Hiroshima University, Japan.
authors.forename: Megu
authors.initials: M
authors.lastname: Ohtaki
mesh_terms: D001195:Asbestosis / Q000266:history* / Q000401:mortality*; D004781:Environmental Exposure / Q000266:history* / Q000706:statistics & numerical data*; D005260:Female; D014943:Global Health; D049673:History, 20th Century; D049674:History, 21st Century; D006801:Humans; D008297:Male; D008654:Mesothelioma / Q000266:history / Q000401:mortality; D010534:Peritoneal Neoplasms / Q000266:history / Q000401:mortality; D012044:Regression Analysis; D017678:Sex Distribution