Ecological association between asbestos-related diseases and historical asbestos consumption: an international analysis.
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.
Lin
Ro-Ting
RT
Department of Environmental Epidemiology, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Yahatanishiku, Kitakyushu, 807-8555, Japan.
Takahashi
Ken
K
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.
Karjalainen
Antti
A
Department of Epidemiology and Biostatistics, Finnish Institute of Occupational Health, Helsinki, Finland.
Hoshuyama
Tsutomu
T
Department of Environmental Epidemiology, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Yahatanishiku, Kitakyushu, 807-8555, Japan.
Wilson
Donald
D
Department of Environmental Epidemiology, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Yahatanishiku, Kitakyushu, 807-8555, Japan.
Kameda
Takashi
T
Department of Environmental Epidemiology, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Yahatanishiku, Kitakyushu, 807-8555, Japan.
Chan
Chang-Chuan
CC
Institute of Occupational Medicine and Industrial Hygiene, College of Public Health, National Taiwan University, Taiwan.
Wen
Chi-Pang
CP
Centre for Health Policy Research and Development, National Health Research Institutes, Taiwan.
Furuya
Sugio
S
Japan Occupational Safety and Health Resource Centre, Tokyo.
Higashi
Toshiaki
T
Department of Work Systems and Health, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Japan.
Chien
Lung-Chang
LC
Department of Biostatistics, School of Public Health, University of North Carolina at Chapel Hill, NC, USA.
Ohtaki
Megu
M
Department of Environmetrics and Biometrics, Research Institute for Radiation Biology and Medicine, Hiroshima University, Japan.
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