title: Recent mortality from pleural mesothelioma, historical patterns of asbestos use, and adoption of bans: a global assessment.
abstract: BACKGROUND
  In response to the health risks posed by asbestos exposure, some countries have imposed strict regulations and adopted bans, whereas other countries have intervened less and continue to use varying quantities of asbestos.
  
  
  OBJECTIVE
  This study was designed to assess, on a global scale, national experiences of recent mortality from pleural mesothelioma, historical trends in asbestos use, adoption of bans, and their possible interrelationships.
  
  
  METHODS
  For 31 countries with available data, we analyzed recent pleural mesothelioma (International Classification of Diseases, 10th Revision) mortality rates (MRs) using age-adjusted period MRs (deaths/million/year) from 1996 to 2005. We calculated annual percent changes (APCs) in age-adjusted MRs to characterize trends during the period. We characterized historical patterns of asbestos use by per capita asbestos use (kilograms per capita/year) and the status of national bans.
  
  
  RESULTS
  Period MRs increased with statistical significance in five countries, with marginal significance in two countries, and were equivocal in 24 countries (five countries in Northern and Western Europe recorded negative APC values). Countries adopting asbestos bans reduced use rates about twice as fast as those not adopting bans. Turning points in use preceded bans. Change in asbestos use during 1970-1985 was a significant predictor of APC in mortality for pleural mesothelioma, with an adjusted R(2) value of 0.47 (p < 0.0001).
  
  
  CONCLUSIONS
  The observed disparities in global mesothelioma trends likely relate to country-to-country disparities in asbestos use trends.
authors.affiliation: Department of Environmental Epidemiology, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Kitakyushu City, Japan.
authors.forename: Kunihito
authors.initials: K
authors.lastname: Nishikawa
authors.forename: Ken
authors.initials: K
authors.lastname: Takahashi
authors.forename: Antti
authors.initials: A
authors.lastname: Karjalainen
authors.forename: Chi-Pang
authors.initials: CP
authors.lastname: Wen
authors.forename: Sugio
authors.initials: S
authors.lastname: Furuya
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Hoshuyama
authors.forename: Miwako
authors.initials: M
authors.lastname: Todoroki
authors.forename: Yoshifumi
authors.initials: Y
authors.lastname: Kiyomoto
authors.forename: Donald
authors.initials: D
authors.lastname: Wilson
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Higashi
authors.forename: Megu
authors.initials: M
authors.lastname: Ohtaki
authors.forename: Guowei
authors.initials: G
authors.lastname: Pan
authors.forename: Gregory
authors.initials: G
authors.lastname: Wagner
mesh_terms: D001194:Asbestos / Q000633:toxicity*; D002273:Carcinogens / Q000633:toxicity*; D014943:Global Health; D006801:Humans; D008654:Mesothelioma / Q000139:chemically induced / Q000401:mortality*; D009026:Mortality / Q000639:trends; D010997:Pleural Neoplasms / Q000139:chemically induced / Q000401:mortality*
chemical_list: D002273:Carcinogens; D001194:Asbestos